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THE   GROWTH   OF  MEDICINE 
FROM   THE   EARLIEST   TIMES   TO   ABOUT    1800 


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Published    on   the    Foundation 
Established  in  Memory  of 

WILLIAM   CHAUNCEY   WILLIAMS 
OF  THE  Class  of   1822,  Yale  Medical  School 

AND    OF 

WILLIAM   COOK   WILLIAMS 
OF  THE  Class  of  1850,  Yale  Medical  School 


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THE  GROWTH  OF  MEDICINE  ^ 


FROM  THE  EARLIEST  TIMES 
TO  ABOUT  1800 


By 
ALBERT  H.   BUCK,   B.A.,   M.D. 

Formerlv  Clinical  Professor  of  Diseases  of  the  Ear,  Columbia 

University,  New  York — Consulting  Aural  Surgeon, 

New  York  Eye  and  Ear  Infirmary;  etc. 


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NEW  HAVEN:  YALE  UNIVERSITY  PRESS 

LONDON:   HUMPHREY  MILFORD 

OXFORD  UNIVERSITY  PRESS 

MDCCCCXVII 


4v 


Copyright,  1917 
By  Yale  University  Press 


First  published,  February,  1917 


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THE  WILLIAMS  MEMORIAL  PUBLICATION 

FUND 

The  present  volume  is  the  first  work  published  by  the 
Yale  University  Press  on  the  Williams  Memorial  Publica- 
tion Fund.  This  Foundation  was  established  June  15, 1916, 
by  a  gift  made  to  Yale  University  by  Dr.  George  C.  F. 
Williams,  of  Hartford,  a  member  of  the  Class  of  1878,  Yale 
School  of  Medicine,  where  three  generations  of  his  family 
studied — his  father,  William  Cook  Williams,  in  the  Class 
of  1850,  and  his  grandfather,  William  Chauncey  Williams, 
in  the  Class  of  1822. 


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PREFACE 

Very  few  persons  will  challenge  the  truth  of  the  state- 
ment that  in  the  United  States  and  Canada  there  are  not 
many  physicians  who  possess  even  a  slight  knowledge 
concerning  the  manner  in  which  the  science  of  medicine 
has  attained  its  present  power  as  an  agency  for  good,  or 
concerning  the  men  who  played  the  chief  parts  in  bringing 
about  this  great  result.  Up  to  the  present  time  no  blame 
may  justly  be  attached  to  any  individuals  or  to  any  educa- 
tional institutions  for  this  prevailing  lack  of  knowledge, 
and  for  two  very  good  reasons,  viz. :  first,  in  a  newly  settled 
country,  in  which  the  population  grows  by  leaps  and 
bounds  through  the  influx  of  foreign  immigrants,  the  train- 
ing of  young  men  for  the  degree  of  M.D.  must  necessarily 
be  almost  entirely  of  a  practical  character,  and  conse- 
quently the  teaching  of  such  a  subject  as  the  history  of 
medicine  would  be  quite  out  of  place;  and,  second,  the 
treatises  on  this  subject  which  are  purchasable  by  English- 
speaking  physicians  are  of  rather  too  scientific  a  character 
to  appeal  either  to  the  undergraduate  or  to  the  busy 
practitioner.  The  first  of  the  reasons  named,  it  may  now 
safely  be  assumed,  is  rapidly  losing  its  validity,  if  indeed 
it  has  not  already  ceased  entirely  to  afford  a  legitimate 
excuse  for  neglecting  the  study  of  this  branch  of  medical 
science.  On  the  other  hand,  the  second  reason  mentioned 
is  still  in  force, — so  far  at  least  as  the  present  writer 
knows, — and,  if  such  be  the  case,  it  certainly  cannot  fail 
to  act  as  a  deterrent  influence  of  great  potency.  Here, 
then,  is  my  apology  for  attempting  to  prepare  an  account 
of  the  history  of  medicine  which  shall  present  the  essential 
facts  truthfully  and  with  a  sufficient  degree  of  attractive- 
ness to  win  the  continuing  interest  of  the  reader;  which 
shall  place  before  him,  and  especially  before  those  who 
are  just  at  the  threshold  of  their  professional  career, 
word  pictures  of  those  physicians  of  past  ages  whose  lives 


X  PREFACE 

may  safely  be  taken  as  models  worthy  to  be  copied;  and 
which  shall  describe,  so  far  as  I  am  able  to  do  this,  the 
methods  which  they  employed  to  advance  the  science  of 
medicine,  to  gain  genuine  professional  success,  and  to 
merit  the  enduring  esteem  of  later  generations  of  physi- 
cians. If  my  efforts  prove  successful  in  producing  this 
kind  of  history  it  is  fair  to  expect  that,  in  a  comparatively 
short  time,  those  physicians  whose  interest  may  have  been 
aroused  by  the  perusal  of  this  less  complete  and  more 
popular  work,  will  demand  something  of  a  more  exhaustive 
character — a  book,  for  example,  like  the  admirable  history 
which  Max  Neuburger,  of  Vienna,  is  now  publishing,  and 
of  which  two  volumes  have  already  issued  from  the  press 
(the  first  in  1906  and  the  second  in  1911)/  It  is  to  this 
work  and  the  excellent  history  written  by  the  late  Dr. 
Haeser,  of  Breslau,  that  I  am  chiefly  indebted  for  the 
information  supplied  in  these  pages ;  and  I  therefore  desire 
to  make  special  mention  here  of  this  indebtedness.  The 
other  sources  from  which  I  have  been  an  occasional 
borrower  are  all  mentioned  in  the  ''List  of  Authorities 
Consulted."  Footnotes  and  cross-references  in  the  text 
interfere  greatly  with  one's  pleasure  in  reading  a  book, 
and  I  have  therefore  not  hesitated  to  introduce  them 
sparingly. 

It  gives  me  a  special  pleasure  to  call  attention  here  to 
the  far-sighted  generosity  displayed  by  the  founder  of 
The  Williams  Memorial  Fund  in  making  it  practicable 
henceforth  for  the  Yale  University  Press  to  accept  for 
publication  medical  treatises  which  deal  with  the  historical 
and  scientific  questions  of  this  branch  of  knowledge,  but 
which  for  sound  business  reasons  cannot  be  published  on 
a  merely  commercial  basis. 

And  I  have  the  further  pleasure  of  expressing  my  real 
appreciation  of  the  skill  with  which  the  University  Press 
has  solved  the  problems  of  a  suitable  size  and  style  of  type 

1  A  third  volume  is  in  course  of  preparation,  but  the  probable  date  of  its 
publication  has  not  been  announced.  An  English  translation  of  the  first 
volume  (by  Ernest  Playfair)  was  published  by  Hodder  and  Stoughton,  of 
London,  in  1910. 


PREFACE  '  xi 

for  this  volume,  and  of  the  sound  advice  which  it  has  given 
with  regard  to  the  extent  to  which  the  effectiveness  of  the 
book  may  be  increased  by  the  introduction  of  pictorial 
illustrations. 

To  my  friend,  Lawrence  F.  Abbott,  of  New  York,  I  am 
deeply  indebted  for  the  valuable  assistance  which  he  has 
rendered  me  throughout  the  entire  progress  of  this  work. 
Indeed,  without  this  assistance,  I  doubt  whether  I  should 
have  had  the  courage  to  remain  at  my  post  to  the  very  end. 

Albert  H.  Buck. 
Cornwall,  N.  Y.,  December  29,  1916. 


CONTENTS 
PART  I.    ANCIENT  MEDICINE 

PAGE 

Preface ix 

Chapter      I.    Development   of   the    Science    and    Art    of 

Medicine        ........  3 

Chapter    II.     Oriental  Medicine       .....         13 

Chapter  III.     Oriental  Medicine   (continued)    .         .         .25 

Chapter  IV.     Greek  Medicine  at  the  Dawn  of  History      .         46 

Chapter  V.  The  Significance  of  the  Serpent  in  the 
Statues  and  Votive  Offerings  Exposed  to  View  in 
the  Aesculapian  Temples         .....         62 

Chapter  VI.     The   Beginnings   of   a   Rational   System   of 

Medicine  in  Greece         ......         67 

Chapter  VII.     Hippocrates  the  Great       ....         81 

Chapter  VIII.     Brief   Extracts   from   Some   of   the    Hip- 

pocratic  Writings  ......         89 

Chapter  IX,  The  State  of  Greek  Medicine  after  the 
Events  of  the  Peloponnesian  War;  the  Founding  of 
Alexandria  in  Egypt,  at  the  Mouth  of  the  Nile;  and 
the  Development  of  Different  Sects  in  Medicine        .         96 

Chapter  X.  Erasistratus  and  Herophilus,  the  Two  Great 
Leaders  in  Medicine  at  Alexandria;  the  Founding 
of  New  Sects 104 

Chapter  XI.  Asclepiades,  the  Introducer  of  Greek  Medi- 
cine into  Rome       .......       116 

Chapter  XII.  The  State  of  Medicine  at  Rome  after  the 
Death  of  Asclepiades;  the  Founding  of  the  School 
of  the  Methodists 129 

Chapter  XIII.  The  Further  History  of  Methodism  at 
Rome,  and  the  Development  of  Two  New  Sects,  viz., 
the  Pneumatists  and  the  Eclectics. — A  General  Sur- 
vey of  the  Subject  of  Sects  in  Medicine  .         .         .       138 


xiv  CONTENTS 


PAGE 


Chapter  XIV.     Well-known  Medical  Authors  of  the  Early 

Centuries  of  the  Christian  Era       ....       151 

Chapter  XV.     Claudius   Galen  .         .  .  .         .160 

Chapter  XVI.     The    Influence    of    Christianity    upon    the 

Evolution  of  Medicine 179 


PART  II.    MEDIAEVAL  MEDICINE 

Chapter  XVII.     The  Condition  of  Medicine  at  Byzantium 

during  the  Early  Part  of  the  Middle  Ages       .  .       191 

Chapter  XVIII.     Beginning  of  the  Arab  Renaissance  under 

the  Caliphs  of  Bagdad  .  .  .  .  .         .203 

Chapter  XIX.  Further  Advance  of  the  Arab  Renaissance 
during  the  Ninth  and  Succeeding  Centuries  of  the 
Christiiin  Era         .         .         .         .         .  .  .212 

Chapter  XX.     Hospitals   and  Monasteries   in   the   Middle 

Ages 235 

Chapter  XXI.     Medical  Instruction  at  Salerno,   Italy,   in 

the  Middle  Ages 243 

Chapter  XXII.  Early  Evidences  of  the  Influence  of  the 
Renaissance  upon  the  Progress  of  Medicine  in  West- 
ern Europe  .......       259 

Chapter  XXIII.  Further  Progress  of  Medicine  and  Sur- 
gery in  Western  Europe  during  the  Thirteenth, 
Fourteenth  and  a  Part  of  the  Fifteenth  Centuries  .       269 

Chapter  XXIV.  During  the  Latter  Half  of  the  Middle 
Ages  Surgery  Assumes  the  Most  Prominent  Place 
in  the  Advance  of  Medical  Science  .  .  .  .       292 

Chapter  XXV.     Brief   History   of   the    Allied    Sciences — 

Pharmacy,  Chemistry  and  Balneotherapeutics  .  .       315 

PART  III.    MEDICINE  DURING  THE  RENAISSANCE 

Chapter  XXVI.  Important  Events  that  Preceded  the 
Renaissance — Early  Attempts  to  Dissect  the  Human 
Body 327 


CONTENTS  XV 

PAGE 

Chapter  XXVII.     The  Founders  of  Human  Anatomy  and 

Physiology  .......       340 

Chapter  XXVIII.  Further  Details  Concerning  the  Ad- 
vance in  Our  Knowledge  of  Anatomy. — Dissecting 
Made  a  Part  of  the  Regular  Training  of  a  Medical 
Student. — latrochemists  and  latrophysicists. — The 
Employment  of  Latin  in  Lecturing  and  "Writing  on 
Medical  Topics 355 

Chapter  XXIX.  The  Contributions  Made  by  Different 
Men  during  the  Renaissance,  and  More  particularly 
by  William  Harvey  of  England,  to  Our  Knowledge 
of  the  Circulation  of  the  Blood,  Lymph  and  Chyle     .       371 

Chapter  XXX.  Advances  Made  in  Internal  Medicine  and 
in  the  Collateral  Branches  of  Botany,  Pharmacology, 
Chemistry  and  Pathological  Anatomy       .  .  .       387 

Chapter  XXXI.  Chemistry  and  Experimental  Pharma- 
cology ........       398 

Chapter  XXXII.  Some  of  the  Leaders  in  Medicine  in 
Italy,  France  and  England  during  the  Sixteenth  and 
Seventeenth  Centuries    ......       411 

Chapter  XXXIII.  The  Three  Leading  Physicians  of  Ger- 
many during  the  Latter  Half  of  the  Seventeenth  Cen- 
tury: Franz  de  le  Boe  Sylvius,  Friedrich  Hoffmann 
and  Georg  Ernst  Stahl 426 

Chapter  XXXIV.  Hermann  Boerhaave  of  Leyden,  Hol- 
land, one  of  the  Most  Distinguished  Physicians  of 
the  Seventeenth  Century         .....       438 

Chapter  XXXV.  General  Remarks  on  the  Development  of 
Surgery  in  Europe  during  the  Fifteenth  and  Six- 
teenth Centuries  .         .         .         .         .         .       446 

Chapter  XXXVI.     Surgery  in  Germany  and  Switzerland 

during  the  Fifteenth  and  Sixteenth  Centuries  .  .       454 

Chapter  XXXVII.     The  Development  of  Surgery  in  Italy 

during  the  Renaissance  .....       472 

Chapter  XXXVIII.     The     Development    of     Surgery     in 

Spain  and  Portugal  during  the  Renaissance   .         .       484 


xvi  CONTENTS 


PAGE 


Chapter  XXXIX.     The  Development  of  Surgery  in  France 

during  the  Renaissance. — Pierre  Franco  .         .         .       490 

Chapter  XL.     The    Development    of    Surgery    in    France 

(continued). — Ambroise  Pare  ....       499 

Chapter  XLI.  Surgery  in  Great  Britain  during  the  Six- 
teenth and  Seventeenth  Centuries  ....       516 

Chapter  XLII.  Reforms  Instituted  by  the  Italian  Surgeon 
Magati  in  the  Treatment  of  Wounds. — Final  Ending 
of  the  Feud  between  the  Surgeons  and  the  Physicians 
of  Paris. — Revival  of  Interest  in  the  Science  of 
Obstetrics 529 

Chapter  XLIII.  The  First  Appearance  of  Syphilis  in 
Europe  as  an  Epidemic  Disease. — Medical  Journal- 
ism.— The  Beginnings  of  a  Modern  Pharmaco- 
poeia.— Itinerant  Lithotomists  ....       542 

List  of  the  More  Important  Authorities  Consulted       .  .       557 

General  Index  ........       563 


LIST  OF  ILLUSTRATIONS 

Fig.     1.     View  of  the  Temple  of  Aesculapius  on  the  Island 

of  Cos  .....     facing  page     52 

Fig.  2.  Bird's-eye  View  of  the  Temple  of  Aesculapius 
and  Associated  Buildings  on  the  Island  of  Cos 

facing  page     54 

Fig.     3.     Ground  Plan  of  the  Asclepieion  on  the   Island 

of  Cos  .....     facing  page    55 

Fig.     4.     Ancient  Statue  of  the  God  Aesculapius  in  the 

Berlin  Museum     ....     facing  page     62 

Fig,     5.     Head  of  the  Marble  Statue  of  the  God  Aesculapius 

in  the  Naples  Museum  .  .     facing  page    62 

Fig.  6.  Bas-relief  of  Aesculapius,  Accompanied  by- 
Women  and  Children,  in  the  Presence  of  an 
Enormous  Serpent        .         .  .     facing  page     68 

Fig.     7.     Female  Bust  Showing  Cancer  of  One  Breast 

facing  page     68 

Fig.     8,     Paralysis  of  the  Left  Facial  Nerve       .     facing  page     70 

Fig.  9.  The  Oldest  Known  Pictorial  Representation  of  a 
Formal  Dissection  of  the  Human  Body 

facing  page  280 

Fig.  10.     The    Manner    of    Giving    Public    Instruction    in 

Medicine  during  the  Middle  Ages  .  .  .281 

Fig.  11.     Henri  de  Monde ville         .  .  .     facing  page  288 

Fig.  12.     One  of  the  Wards  in  the  Hotel-Dieu  of  Paris 

facing  page  304 

Fig.  13.     The  Physician,  the  Surgeon  and  the  Pharmacist 

facing  page  306 
Fig.  14.     Andreas  Vesalius      .  .  .  .     facing  page  344 

Fig.  15.     William  Harvey        ....     facing  page  380 
Fig.  16.     "The  Lovesick  Maiden"   .  .         .     facing  page  412 

Fig.  17.     Thomas  Sydenham  .         .         .     facing  page  418 


xvin  LIST  OF  ILLUSTRATIONS 

Fig.  18.     Consultation  by  Three  Physicians  upon  a  Case 

of  Wound  in  the  Chest         .         .         .         .457 

Fig,  19.  Barber  Surgeon  (Wundarzt)  Extracting  an 
Arrow  from  a  Wounded  Soldier's  Chest  while 
the  Battle  is  Still  in  Progress       .         .         .       461, 

Fig.  20.     Amputation  of  the  Leg 463 

Fig.  21.  The  Manner  in  Which  the  So-called  Tagliacotian 
Operation  for  Repairing  a  Defective  Nose 
Should  be  Carried  Out  .         .         .         .480 

Fig.  22.     Pierre  Franco's  Forceps  for  Crushing  Calculi  in 

the  Urinary  Bladder     .....       497 

Figs.  23-24.  Forceps  Devised  in  1552  by  Ambroise  Pare  for 
Drawing  Out  the  Cut  Ends  of  Arteries  after 
the  Amputation  of  a  Limb,  and  Holding  Them 
while  the  Ligature  is  Being  Applied       .  .       512 

Fig.  25.     Ambroise  Pare,  the  Famous  French  Surgeon  of 

the  Sixteenth  Century  ,  .     facing  page  514 

Fig.  26.     Frere  Jacques  de  Beaulieu       .  .     facing  page  550 

Fig.  27.     Jean  Baseilhac,  commonly  Known  in  France  as 

Frere  Come  ....     facing  page  552 

Fig.  28.     Concealed  Lithotome  Invented  by  Frere  Come  in 

1748  553 


PART  I 
ANCIENT  MEDICINE 


CHAPTER  1 

DEVELOPMENT  OF  THE  SCIENCE  AND  ART 
OF  MEDICINE 

Friedlaender  says  that  *4n  the  temple  of  history,  now 
hoary  with  age,  medicine  also  possesses  its  own  chapel, 
not  an  accidental  addition  to  the  edifice  but  a  large  and 
important  part  of  the  noble  building."  In  this  chapel  is 
preserved  the  record  of  the  efforts  made  by  man,  through 
the  ages,  to  maintain  his  body  in  good  condition,  to  restore 
it  to  health  when  it  has  become  affected  by  disease  or 
damaged  by  violence,  and  to  ward  off  the  various  maladies 
to  which  it  is  liable.  It  is  a  record,  therefore,  in  which 
every  practitioner  of  medicine  should  take  a  deep  interest. 
Rokitansky,  the  famous  pathologist  of  Vienna,  expressed 
the  same  idea  very  tersely  when  he  said:  ** Those  about 
to  study  medicine  and  the  younger  physicians  should  light 
their  torches  at  the  fires  of  the  ancients."  Members  of  the 
medical  profession,  however,  are  not  the  only  persons  in 
the  community  who  take  an  interest  in  the  origin  and 
growth  of  the  science  of  medicine  and  the  art  of  healing 
the  diseased  or  damaged  body ;  the  educated  layman  is  but 
little  less  interested  than  the  physician,  being  ever  ready 
to  learn  all  he  can  about  the  progress  of  a  branch  of  knowl- 
edge which  so  profoundly  affects  his  welfare.  But  hitherto 
the  only  sources  of  information  available  for  those  who  are 
not  familiar  with  French  or  German  have  been  treatises  of 
so  technical  a  character  that  even  physicians  have  shown 
relatively  little  disposition  to  read  them. 

The  science  of  medicine  developed  slowly  from  very 
humble  beginnings,  and  for  this  earliest  period  the  historian 
has  no  records  of  any  kind  which  may  be  utilized  for  his 


4  GROWTH  OF  MEDICINE 

guidance.  It  is  reasonably  certain,  furthermore,  that  this 
prehistoric  period  lasted  for  a  very  long  time,  probably 
several  thousand  years;  and  when,  finally,  some  light  on 
the  subject  appeared,  it  was  found  to  emanate  from  several 
widely  separated  regions — e.g.,  from  India,  Mesopotamia, 
Egypt  and  Greece.  Then,  after  the  lapse  of  additional 
hundreds  or  even  thousands  of  years,  there  was  inaugurated 
the  practice  of  making  written  records  of  all  important 
events,  and,  among  others,  of  the  different  diseases  which 
affect  mankind,  of  the  means  employed  for  curing  them  or 
for  relieving  the  effects  which  they  produce,  and  of  the  men 
who  distinguished  themselves  in  the  practice  of  this  art. 
While  the  ''science  of  the  spade"  and  that  of  deciphering 
the  writing  of  the  papyri,  monuments  and  tablets  thus 
brought  to  light,  have  already  during  the  last  half  century 
greatly  altered  our  ideas  with  regard  to  ancient  medicine, 
there  are  good  reasons  for  believing  that  much  additional 
information  upon  this  subject  may  be  looked  for  in  the  not 
distant  future.  It  is  plain,  therefore,  that  a  history  of  the 
primitive  period  of  medicine,  if  written  to-day,  may  have 
to  be  modified  to-morrow  in  some  important  respects.  On 
the  other  hand,  the  facts  relating  to  the  later  periods  are 
now  so  well  established  that  a  fair-minded  writer  should 
experience  no  serious  difficulty  in  judging  correctly  with 
regard  to  their  value  and  with  regard  to  the  claims  of  the 
different  men  to  be  honored  for  the  part  which  each  has 
played  in  bringing  the  science  and  art  of  medicine  to  their 
present  high  state  of  completeness  and  efficiency. 

The  subdivision  of  the  history  of  medicine  into  separate 
periods  is  certainly  desirable,  provided  it  be  found  prac- 
ticable to  assign  reasonably  well-defined  limits  to  the 
periods  chosen.  But,  when  the  attempt  is  made  to  establish 
such  subdivisions,  one  soon  discovers  that  the  boundaries 
pass  so  gradually  the  one  into  the  other  at  certain  points, 
or  else  overlap  so  conspicuously  at  other  points,  that  one 
hesitates  to  adopt  any  fixed  plan  of  classification.  Of 
the  four  schemes  which  I  have  examined — viz.,  those  of 
Daremberg,  of  Aschoff,  of  Neuburger,  and  of  Pagel — that 
of  Neuburger  seems  to  me  to  be  the  best.    That  which  has 


BEGINNINGS  OF  MEDICINE  5 

been  adopted,  however,  in  the  preparation  of  the  present 
outline  sketch  combines  some  of  the  features  of  both  the 
Pagel  and  the  Neuburger  schemes. 

Periods  in  the  History  of  Medicine. — There  are  nine 
more  or  less  distinctly  defined  periods  in  the  history  of 
medicine,  to  wit: — 

First  Epoch  :  Primitive  medicine. — This  period  extends 
through  prehistoric  ages  to  a  date  which  differs  for 
different  parts  of  the  world.  The  duration  of  this  period, 
in  any  case,  is  to  be  reckoned  by  thousands  of  years. 

Second  Epoch:  The  medicine  of  the  East — that  is,  of 
the  cultivated  oriental  races  of  whose  history  we  possess 
only  a  very  fragmentary  knowledge. 

Third  Epoch:  The  medicine  of  the  classical  period  of 
antiquity — the  pre-Hippocratic  period  of  Greek  medicine. 

Fourth  Epoch  :  The  medicine  of  the  Hippocratic  writ- 
ings— the  most  flourishing  period  of  Greek  medicine. 

Fifth  Epoch  :  The  medicine  of  the  period  during  which 
the  centre  of  greatest  intellectual  activity  was  located  at 
Alexandria,  Egypt. 

Sixth  Epoch  :  The  medicine  of  Galen — an  author  whose 
teachings  exerted  a  preponderating  influence  upon  the 
thought  and  practice  of  physicians  in  every  part  of  the 
civilized  world  up  to  the  seventeenth  century  of  the 
Christian  era.  This  period  is  also  characterized  by  the 
gradual  diminution  of  the  influence  of  Greek  medicine. 

Seventh  Epoch:  The  medicine  of  the  Middle  Ages — a 
period  which  includes  a  large  part  of  the  preceding  epoch. 
Its  most  characteristic  feature  is  the  important  part  played 
by  the  Arabs  in  moulding  the  teachings  and  practice  of  the 
medical  men  of  that  time  (ninth  to  fifteenth  century). 

Eighth  Epoch  (fifteenth  and  sixteenth  centuries) :  The 
medicine  of  the  Renaissance  period — characterized  chiefly 
by  the  adoption  of  the  only  effective  method  of  studying 
the  anatomy  of  man — the  actual  dissection  of  human  bodies. 

Ninth  Epoch  (from  the  beginning  of  the  seventeenth 
century  to  the  present  time) :  Modern  medicine. — This 
epoch  may  with  advantage  be  divided  into  two  periods — 
the  first  extending  to  about  the  year  1775,  soon  after  which 


6  GROWTH  OF  MEDICINE 

time  Jenner  began  Ms  important  work  on  the  subject  of 
vaccination;  and  the  second  to  the  present  time.  No 
attempt  will  be  made  in  the  following  account  to  cover  this 
second  period. 

The  Beginnings  of  Medicine. — In  the  early  period  of 
man's  existence  upon  this  earth  he  must  have  possessed 
an  exceedingly  small  stock  of  knowledge  with  regard  to 
the  maintenance  of  his  body  in  health  and  with  regard  to 
the  means  which  he  should  adopt  in  order  to  restore  it  to 
a  normal  condition  after  it  had  been  injured  by  violence 
or  impaired  in  its  working  machinery  by  disease.  With  the 
progress  of  time,  utilizing  his  powers  of  observation  and 
his  reasoning  faculty,  he  slowly  made  additions  to  his  stock 
of  facts  of  this  nature.  Thus,  for  example,  he  gradually 
learned  that  cold,  under  certain  circumstances,  is  competent 
to  produce  pain  in  the  chest,  shortness  of  breath,  active 
secretion  of  mucus,  etc.,  and  his  instinct  led  him,  when  he 
became  affected  in  this  manner,  to  crave  the  local  appli- 
cation of  heat  as  a  means  of  affording  relief  from  these 
distressing  symptoms.  Again,  when  he  used  certain  plants 
as  food  he  could  scarcely  fail  to  note  the  facts  that  some 
of  them  produced  a  refreshing  or  cooling  effect,  that  others 
induced  a  sensation  of  warmth,  and  finally  that  others  still, 
by  reason  of  their  poisonous  properties,  did  actual  harm. 
Sooner  or  later,  such  phenomena  as  nausea,  vomiting  and 
diarrhoea  would  also  be  attributed  by  him  to  their  true 
causes.  In  due  course  of  time  his  friends  and  neighbors, 
having  made  similar  observations  and  having  tried  various 
remedial  procedures  for  the  relief  of  their  bodily  ills,  would 
come  together  and  compare  with  him  their  several  expe- 
riences; and  so  eventually  the  fact  would  be  brought  out 
that  the  particular  method  adopted  by  one  of  their  number 
for  the  relief  of  certain  symptoms  had  proved  more 
effective  than  any  of  the  others.  Thus  gradually  this 
isolated  community  or  tribe  of  men  must  have  learned  how 
to  treat,  more  or  less  successfully,  the  simpler  ills  to  which 
they  were  liable. 

Lucien  Le  Clerc  quotes  from  the  Arab  historian  Ebn  Abi 
Ossaibiah  the  following  account  of  the  manner  in  which 


BEGINNINGS  OF  MEDICINE  7 

bloodletting  probably  first  came  to  be  adopted  as  a  remedial 
measure : — 

Let  us  suppose  that  in  the  earliest  period  of  man's  history  some- 
body experienced  the  need  of  the  medical  art.  He  may,  for 
example,  have  felt  a  general  sense  of  heaviness  in  his  body 
(plethora),  associated  perhaps  with  redness  of  the  eyes,  and  he 
probably  did  not  know  what  he  should  do  in  order  to  obtain  relief 
from  these  sensations.  Then,  when  his  trouble  was  at  its  worst, 
his  nose  began  to  bleed,  and  the  bleeding  continued  until  he 
experienced  decided  relief  from  his  discomfort.  In  this  way  he 
learned  an  important  fact,  and  cherished  it  in  his  memory. 

On  a  later  occasion  he  experienced  once  more  the  same  sense 
of  heaviness,  and  he  lost  no  time  in  scratching  the  interior  of  his 
nose  in  order  to  provoke  a  return  of  the  bleeding.  The  nose- 
bleed thus  excited  again  gave  him  entire  relief  from  the  unpleasant 
sensations,  and  upon  the  first  convenient  occasion  he  told  his 
children  and  all  his  relatives  about  the  successful  results  obtained 
from  this  curative  procedure.  Little  by  little  this  simple  act, 
which  was  a  first  step  in  the  healing  art,  developed  into  the 
intelligently  and  skilfully  performed  operation  of  venesection. 

Primitive  man  also  increased  bis  stock  of  knowledge  in 
the  healing  art  by  reading  attentively  the  book  of  nature, — 
i.e.,  by  observing  how  animals,  when  ill,  eat  the  leaves  or 
stems  of  certain  plants  and  thus  obtain  relief  from  their 
disorders.  The  virtues  of  a  species  of  origanum,  as  an 
antidote  for  poisoning  from  the  bite  of  a  snake,  were 
revealed,  it  is  asserted,  by  the  observation  that  turtles, 
when  bitten  by  one  of  these  reptiles,  immediately  seek  for 
the  plant  in  question  and,  after  feeding  upon  it,  experience 
no  perceptible  ill  effects  from  the  poisonous  bite.  The 
natives  of  India  ascribe  the  discovery  of  the  remarkable 
virtues  of  snakeroot  (the  bitter  root  of  the  ophiorrhiza 
Mungos)  as  an  antidote  for  poisoning  by  the  bite  of  a  snake, 
to  the  ichneumon,  a  small  animal  of  the  rat  species.  The 
instinctive  desire  to  escape  pain  taught  man,  as  it  does  the 
lower  animals,  to  keep  a  fractured  limb  at  rest,  thus  giving 
the  separated  ends  of  the  bone  an  opportunity  to  reunite; 
after  which  the  limb  eventually  becomes  as  strong  as  it 
ever  was.    Simple  as  this  mode  of  acquiring  useful  medical 


8  GROWTH  OF  MEDICINE 

knowledge  may  appear  to  us  moderns,  there  are  good 
reasons  for  believing  that  hundreds  of  years  must  have 
elapsed  before  the  accumulated  stock  of  such  experiences 
became  really  considerable.  On  the  other  hand,  it  is 
reasonable  to  suppose  that  this  growth  in  medical  knowl- 
edge took  place  more  rapidly  in  certain  tribes  or  races  than 
in  others,  and  that  when,  under  the  action  of  wars,  the 
inferior  men  became  tributary  to  those  of  greater  intel- 
lectual powers,  they  acquired,  through  contact  with  their 
conquerors,  additional  knowledge  at  a  much  more  rapid 
rate.  One  great  hindrance,  however,  stood  in  the  way  of 
such  progress.  I  refer  to  the  deeply  rooted  belief,  enter- 
tained by  man  in  this  primitive  period  of  his  existence,  in 
the  agency  of  malevolent  spirits  (demons)  in  the  production 
of  disease, — a  belief  which  continued  to  exist  for  many 
thousands  of  years.  Out  of  such  a  belief  developed  the 
necessity  of  discovering  some  practical  method  of  appeasing 
the  evil  spirits  and  of  thus  obtaining  the  desired  cure  of 
the  ills  of  the  body.  Usually  some  member  of  the  tribe 
who  had  displayed  special  skill  in  the  treatment  of  disease, 
and  who  at  the  same  time  was  liberally  endowed  with  the 
qualities  which  characterize  the  charlatan,  was  chosen  to 
be  the  priest  or  ''medicine  man."  It  was  his  duty  to 
employ  measures  suitable  for  expelling  the  demon  from 
the  patient's  body  and  for  restoring  the  latter  to  health. 
Possessing  great  influence,  as  these  superstitious  people 
believed  he  did,  with  the  unseen  gods,  such  a  physician- 
priest  must  have  discouraged  all  efforts  to  increase  the 
stock  of  genuine  medical  knowledge;  for  such  an  increase 
would  necessarily  mean  a  diminution  of  his  own  power 
and  influence. 

In  what  must  still  be  termed  the  age  of  primitive  medi- 
cine, but  undoubtedly  at  an  advanced  stage  of  that  epoch, 
there  were  performed  surgical  operations  which  imply  a 
remarkable  advance  in  the  invention  of  cutting  instruments 
and  in  the  knowledge  of  the  location  and  nature  of  certain 
comparatively  rare  diseases,  and  at  the  same  time  great 
courage  and  wonderful  enterprise  on  the  part  of  those 
early  physicians.    As  evidence  of  the  correctness  of  these 


BEGINNINGS  OF  MEDICINE  9 

statements  the  fact  may  be  mentioned  that  trepanned  skulls 
belonging  to  the  neolithic  period  have  been  dug  up  in 
various  parts  of  the  world — in  most  of  the  countries  of 
Europe,  in  Algiers,  in  the  Canary  Islands,  and  in  both 
North  and  South  America.  From  a  careful  study  of  these 
skulls  it  has  been  learned  that  the  individuals  upon  whom 
such  severe  surgical  work  had  been  done — sometimes  as 
often  as  three  separate  times — recovered  from  the  opera- 
tion. The  instruments  used  were  made  of  sharpened  flint 
(saws  or  chisels).  Pain  in  the  head,  spasms  or  convulsions, 
and  mental  disorders  are  suggested  by  Neuburger  as  the 
indications  which  probably  led  to  the  performance  of  the 
trepanning.  This  author  also  makes  the  further  statement 
that  the  ancient  Egyptians  employed  knives  made  of  flint 
for  opening  the  dead  bodies  which  they  were  about  to 
embalm  and  for  the  operation  of  circumcision.  Recent 
excavations  have  thrown  additional  light  upon  the  state 
of  medical  knowledge  during  this  neolithic  age.  Thus, 
there  have  been  found  specimens  of  anchylosed  joints,  of 
fractured  bones,  of  flint  arrow  heads  lodged  in  different 
parts  of  the  skeleton,  of  rhachitis,  of  caries  and  necrosis 
of  bone,  etc.  The  following  quotation  is  taken  from  the 
printed  report  of  a  lecture  recently  delivered  in  London 
by  Dr.  F.  M.  Sandwith,  Consulting  Surgeon  to  the  Khedive 
of  Egypt.  Speaking  of  certain  excavations  made  in  the 
Nubian  Desert  and  of  the  oldest  surgical  implements  yet 
discovered,  he  says : — 

In  one  place  a  graveyard  was  found,  and  here  were  remains  of 
bodies  with  fractured  limbs  that  had  been  set  with  bark  splints. 
One  was  a  right  thigh  bone  that  had  been  broken,  and  was  still 
held  in  position  by  a  workmanlike  splint  and  bandages.  All  the 
knots  were  true  reef-knots,  and  the  wrappings  showed  how  the 
strips  of  palm-fibre  cloth  were  set  just  as  a  good  surgeon  would 
set  them  in  these  days  so  as  to  use  the  full  strength  of  the  fabric. 

Among  the  most  ancient  remedies  may  be  mentioned 
talismans,  amulets  and  medicine  stones,  which  were  fur- 
nished— presumably  at  a  price — by  the  physician-priests, 
and  which  were  believed  to  afford  the  wearers  protection 


10  GROWTH  OF  MEDICINE 

against  evil  spirits  (the  **evil  eye,"  for  example).  Various 
objects  were  used  for  this  purpose,  and  among  them  the 
following  deserve  to  be  mentioned :  disks  of  bone  removed 
with  the  aid  of  a  trephine  from  the  skull  of  a  dead  human 
body  and  worn  with  a  string  around  the  neck ;  the  teeth  of 
different  animals;  bones  of  the  weasel;  cats'  claws;  the 
lower  jaw  of  a  squirrel;  the  trachea  of  some  bird;  one  of 
the  vertebrae  of  an  adder,  etc.  And  where  these  measures 
failed,  the  priests  resorted  to  incantations,  religious  dances, 
and  the  beating  of  drums  or  the  rattling  of  dried  gourds 
filled  with  pebbles.  Primitive  races  of  men  inhabiting  the 
most  widely  separated  parts  of  the  earth  appear  to  have 
adopted  means  almost  identical  with  those  just  described 
for  driving  away  evil  spirits.  The  holding  of  these  super- 
stitious beliefs  is  one  of  the  most  extraordinary  character- 
istics of  the  human  race.  It  played  an  important  part 
throughout  the  classical  period  of  Greek  and  Eoman 
civilization,  and  also  during  the  Middle  Ages.  Christianity 
undoubtedly  was  a  most  potent  agency  in  hastening  the 
eradication  of  the  feeling,  but  even  this  great  power  has 
not  yet  sufficed  entirely  to  do  away  with  superstition;  for 
traces  of  this  weakness  may  still  easily  be  detected  in  some 
of  the  men  and  women  with  whom  we  daily  come  in  contact. 


CHAPTEK  II 
ORIENTAL  MEDICINE 

The  researches  of  the  scholar  working  in  combination 
with  the  engineer  have  unearthed — ^more  particularly  in 
Mesopotamia,  in  Egypt  and  in  Greece — evidences  of  an 
ancient  medical  science  far  advanced  beyond  that  briefly 
described  in  the  preceding  chapter.  These  evidences  relate 
to  nations  that  flourished  as  far  back  as  four  thousand 
years  B.  C.  While  they  are  very  fragmentary  and  cover 
historical  events  which  are  often  separated  from  one 
another  by  long  periods  of  time,  these  data  nevertheless 
suffice  to  give  one  a  fairly  good  idea  of  the  then  prevailing 
state  of  medical  knowledge.  Both  Pagel  and  Neuburger 
adopt  the  plan  of  discussing  these  different  nationalities 
separately,  and  I  shall  follow  their  example. 

Medicine  in  Mesopotamia. — As  appears  from  the  most 
recent  investigations  the  Sumerians  were  the  first  occu- 
pants of  the  region  lying  between  the  Euphrates  and  the 
Tigris  rivers.  It  was  from  them  that  their  Semitic  con- 
querors, the  Babylonians  and  the  Assyrians,  received  a 
civilization  which,  already  about  4000  B.  C,  had  reached 
a  wonderful  degree  of  development.  The  canalization  of 
the  low-lying  lands  of  that 'region,  the  organization  of  a 
religious  and  civil  government  of  a  most  efficient  type,  the 
invention  first  of  picture-writing  and  then  of  the  cuneiform 
characters,  the  cultivation  of  the  arts  and  natural  sciences 
and  especially  of  astronomy  and  mathematics  to  a  high 
degree  of  perfection, — these  are  among  the  things  which 
were  accomplished  by  this  very  clever  race  of  men.  In 
addition,  however,  to  these  useful  activities  the  Babylo- 
nians developed  and  cultivated  diligently  the  science  of 
astrology — that  is,  the  science  of  predicting  human  events 


12  GROWTH  OF  MEDICINE 

(such  as  the  death  of  the  king,  the  occurrence  of  the  plague 
or  of  war,  etc.)  from  various  telluric  and  cosmic  phe- 
nomena— an  eclipse  of  the  sun,  peculiarities  of  the 
weather,  the  condition  of  vegetation,  etc.  The  deeply- 
rooted  love  of  the  human  race  for  the  supernatural — a 
characteristic  to  which  I  have  already  briefly  referred — 
facilitated  the  development  of  this  harmful  practice,  and 
kept  it  alive  through  many  succeeding  centuries.  Walter 
Scott,  in  his  romance  entitled  Quentin  Durward,  gives  an 
admirable  portrait  of  a  typical  astrologer  whom  Louis  XI. 
of  France  maintained  at  his  court  during  a  part  of  the 
seventeenth  century. 

While  in  other  parts  of  the  Orient  the  science  of  medi- 
cine, as  already  stated  at  the  beginning  of  this  chapter, 
made  a  noteworthy  advance  beyond  the  conditions  observed 
among  the  primitive  races,  in  Mesopotamia  this  science, 
which  was  far  more  important  to  the  welfare  of  its  inhabi- 
tants than  all  the  other  branches  of  knowledge  combined, 
received  very  little  attention  and  consequently  made  only 
insignificant  advances.  The  British  Museum  has  in  its 
possession  several  thousand  tablets  which  were  dug  up 
from  the  ruins  of  Nineveh  and  which  represent  a  part  of 
the  library  of  the  Assyrian  King,  Assurbanipal  (668-626 
B.  C).  Translations  of  the  text  of  only  a  very  few  of 
these  tablets  have  thus  far  been  published,  and  from  these, 
which  embody  the  greater  part  of  our  knowledge  of 
Assyrian  medicine,  it  appears  that,  for  the  present  at  least, 
the  estimate  recorded  above  must  stand.  A  few  new  facts, 
however,  have  been  brought  to  light,  and  they  appear  to 
be  of  sufficient  importance  to  merit  brief  consideration  here. 

In  the  first  place,  Herodotus,  who  visited  Babylon  about 
300  B.  C,  has  this  to  say  in  relation  to  the  state  of  medicine 
in  that  city: — 

The  following  custom  seems  to  me  the  wisest  of  their  institutions 
next  to  the  one  lately  praised.  They  have  no  physicians,  but,  when 
a  man  is  ill,  they  lay  him  in  the  public  square,  and  the  passers-by 
come  up  to  him,  and  if  they  have  ever  had  his  disease  themselves 
or  have  known  any  one  who  has  suffered  from  it,  they  give  him 
advice,  recommending  him  to  do  whatever  they  found  good  in  their 


ORIENTAL  MEDICINE  13 

own  case,  or  in  the  case  known  to  them;  and  no  one  is  allowed  to 
pass  the  sick  man  in  silence  without  asking  him  what  his  ailment  is.^ 

The  Babylonians  held  some  rather  strange  beliefs 
regarding  the  construction  of  the  human  body  and  the 
manner  in  which  its  functions  are  performed.  The  living 
being,  as  they  maintained,  is  composed  of  soul  and  body. 
The  intellect  has  its  seat  in  the  heart,  the  liver  serving  as 
the  central  organ  for  the  blood,  which  they  considered  to 
be  the  true  life  principle.  They  divided  this  fluid  into  two 
kinds — blood  of  the  daytime  (bright  arterial)  and  that  of 
the  night  (dark  venous).  Although  the  blood  was  held 
by  them  to  be  the  basis  of  life,  they  evidently  attached  a 
certain  value  to  respiration,  for  one  of  their  prayers  begins 
with  these  words :  *  *  God,  my  creator,  lead  me  by  the  hand ; 
guide  the  breath  of  my  mouth. '  *  Disease  was  always  looked 
upon  as  something  (usually  personified  as  a  demon)  that 
entered  the  body  from  without  and  that  consequently  had 
to  be  expelled.  There  were  special  demons  for  the  different 
diseases.  Thus,  Asakku  brought  fever  to  the  head,  Namtar 
threatened  life  with  the  plague,  and  Utukku  attacked  the 
throat,  Alu  the  breast,  Gallu  the  hand,  Rabisu  the  skin,  and 
so  on.  The  most  dreaded  demons  were  the  spirits  of 
the  dead.  Special  amulets  were  employed  as  protective 
remedies.  Prayer  formulae  were  also  used.  Here  is  one 
among  several  that  I  find  mentioned  in  Neuburger's 
treatise : — 

Wicked  Consumption,  villainous  Consumption,  Consumption 
which  never  leaves  a  man,  Consumption  which  cannot  be  driven 
away,  Consumption  which  cannot  be  induced  to  leave.  Bad 
Consumption,  in  the  name  of  Heaven  be  placated,  in  the  name  of 
Earth  I  conjure  thee ! 

The  genuine  remedial  agents  employed  in  Babylonia 
were  of  a  most  varied  nature:  a  mixture  of  honey  and 
syrup  of  dates;  medicinal  herbs  of  different  kinds  for 
internal  administration;  bloodletting;  the  use  of  cups  for 
drawing  blood  to  the  surface  of  the  body ;  warm  baths  and 

1  Book  I,,  section  197,  of  Eawlinson's  translation. 


14  GROWTH  OF  MEDICINE 

cold  shower  baths;  rubbing  oil  over  the  body;  medicated 
clysters;  the  use  of  various  salves;  the  use  of  secret 
remedies  which  were  composed  of  various  ingredients  and 
which  bore  such  names  as  *'the  Sun  God's  remedy,"  **the 
dog's  tongue,"  "the  skin  of  the  yellow  snake,"  ''the 
medicine  brought  from  the  mountain  of  the  human  race," 
etc. 

Some  of  the  predictions  made  by  the  Babylonian  astrolo- 
gers are  of  sufficient  interest  to  be  placed  on  record.  Here 
are  a  few  examples : — 

If  the  west  wind  is  blowing  when  the  new  moon  is  first  seen, 
there  is  hkely  to  be  an  unusual  amount  of  illness  during  that 
month. 

If  Venus  approaches  the  constellation  of  Cancer,  there  will  be 
respect  for  law  and  prosperity  in  the  land;  those  who  are  ill  will 
recover,  and  pregnant  women  will  have  easy  confinements. 

If  Mercury  makes  its  appearance  on  the  fifteenth  day  of  the 
month,  there  will  be  corpses  in  the  land.  And  again,  if  the  con- 
stellation of  Cancer  is  obscured,  a  destructive  demon  will  take 
possession  of  the  land,  and  there  will  be  corpses. 

If  Jupiter  and  the  other  planets  stand  opposite  one  another, 
some  calamity  will  overtake  the  land.  If  Mars  and  Jupiter  come 
into  conjunction,  there  will  be  deaths  among  the  cattle. 

If  an  eclipse  of  the  Sun  take  place  on  the  twenty-eighth  day  of 
the  month  I  jar,  the  king  will  have  a  long  reign ;  but,  if  it  take  place 
on  the  twenty-ninth  day  of  the  month,  there  will  be  corpses  on  the 
first  day  of  the  following  month. 

If  there  should  be  thunder  during  the  month  of  Tisri,  a  spirit  of 
enmity  will  prevail  in  the  land ;  and  if  it  should  rain  during  that 
month,  both  men  and  cattle  will  fall  ill. 

Besides  these  predictions,  which  were  based  upon  phe- 
nomena connected  with  the  movements  of  the  stars  and  the 
conditions  of  the  weather,  there  were  others  which  the 
people  themselves  were  competent  to  make  without  the  aid 
of  the  professional  astrologer  or  the  official  priest.  Such, 
for  example,  are  the  following  ** omens": — 

If  a  woman  gives  birth  to  a  child  the  right  ear  of  which  is  lacking, 
long  will  be  the  reign  of  the  prince  of  that  land. 

If  a  woman  gives  birth  to  a  child  both  of  whose  ears  are  lacking, 


ORIENTAL  MEDICINE  15 

sadness  will  come  upon  the  land  and  it  will  lose  some  of  its 
importance. 

If  a  woman  gives  birth  to  a  child  whose  face  resembles  the  beak 
of  a  bird,  there  will  surely  be  peace  in  the  land. 

If  a  woman  gives  birth  to  a  child  the  right  hand  of  which  lacks 
fingers,  the  sovereign  of  that  country  will  be  taken  prisoner  by  his 
enemies. 

The  keen  interest  taken  by  the  priests  in  the  matter  of 
predicting  the  outcome  of  various  diseases  led  in  due  time 
to  their  making  records  of  the  nature,  symptoms  and 
progress  of  the  latter.  Although  this  practice  was  inaugu- 
rated purely  for  the  purpose  of  enabling  them  to  foretell 
with  greater  accuracy  the  probable  issue  of  any  given 
malady,  it  nevertheless  served  also  to  establish  on  a  firm 
basis  the  custom  of  keeping  records  of  the  case-histories. 
Only  one  thing  more  was  now  needed  to  render  this 
practice  the  first  step  in  a  genuine  advance  of  medical 
knowledge;  but  this  step  could  not  be  made  in  Babylonia, 
where  priestcraft  and  superstition  had  struck  such  deep 
roots  in  the  public  life.  It  was  only  in  free  Greece,  and  at 
a  time  in  its  history  when  the  spirit  of  Hippocrates  exerted 
an  overpowering  influence  over  the  minds  of  men,  that  the 
separation  of  the  functions  of  the  physician  from  those  of 
the  priest  became  possible  and  was  in  due  time  effected. 
(Neuburger.) 

Before  closing  this  very  incomplete  account  of  the  state 
of  medical  knowledge  in  Babylonia,  it  will  be  well  to  mention 
some  of  the  items  of  the  law  laid  down  by  Hammurabi 
(circa  2200  B.  C.)  for  the  guidance  of  the  physicians  of  that 
land  with  regard  to  the  remuneration  which  they  should 
receive.  At  the  same  time  I  shall  make  no  attempt  to 
reconcile  the  statement  of  Herodotus  (given  on  page  12) 
with  the  wording  of  this  law,  which  distinctly  recognizes 
the  existence  of  physicians  in  Mesopotamia.  Possibly  the 
conditions  in  Nineveh  in  the  fourth  century  B.  C.  were 
different  from  what  they  had  been  eighteen  centuries 
earlier. 

If  a  physician  makes  a  deep  cut  with  an  operating  knife  of 
bronze  and  effects  a  cure,  or  if  with  such  a  knife  he  opens  a  tumor 


16  GROWTH  OF  MEDICINE 

and  thus  avoids  damaging  the  patient's  eye,  he  shall  receive  as  his 
reward  10  shekels  of  silver.  If  the  patient  is  an  emancipated  slave, 
the  fee  shall  be  reduced  to  5  shekels.  In  the  case  of  a  slave  the 
master  to  whom  he  belongs  shall  pay  the  physician  2  shekels. 

If  a  physician  makes  a  deep  wound  with  an  operating  knife  of 
bronze  and  the  patient  dies,  or  if  he  opens  a  tumor  with  such  a 
knife  and  the  patient 's  eye  is  thereby  destroyed,  the  operator  shall 
be  punished  by  having  his  hands  cut  off. 

If  a  physician,  in  operating  upon  the  slave  of  a  freedman,  makes 
a  deep  wound  with  an  operating  knife  of  bronze  and  thus  kills  the 
patient,  he  shall  give  the  owner  a  slave  in  exchange  for  the  one 
killed.  And  if,  in  opening  a  tumor  with  such  a  knife,  the  physician 
destroys  the  slave's  eye,  he  shall  pay  to  the  latter 's  owner  one-half 
the  slave 's  value. 

If  a  physician  effects  the  healing  of  a  broken  bone  or  cures  a 
disease  of  the  intestines,  he  shall  receive  from  the  patient  a  fee 
of  5  shekels  of  silver.^ 

It  would  be  difficult  to  imagine  anything  better  adapted 
to  arrest  the  development  of  medical  knowledge  in  a  nation 
than  the  promulgation  of  a  law  like  that  ascribed  to 
Hammurabi ;  and  one  cannot  be  surprised  at  the  statement 
made  by  Herodotus,  eighteen  centuries  later,  ''that  there 
were  no  physicians  in  Babylon. ' '  Foolhardy,  indeed,  would 
be  the  man  who,  for  the  sake  of  earning  a  possible  reward 
of  six  shekels  of  silver,  would  be  willing  to  risk  the  danger 
of  having  both  his  hands  cut  off;  and  yet  every  conscien- 
tious and  faithful  practitioner  of  medicine  in  Babylon  at 
the  time  mentioned  must  necessarily  have  been  obliged  to 
run  this  risk. 

Medicine  in  Ancient  Egypt. — Of  the  sources  of  informa- 
tion with  regard  to  the  knowledge  of  medicine  possessed 
by  the  ancient  Egyptians  the  most  important  are  the 
following:  Homer's  Odyssey;  Herodotus;  Diodorus; 
Clemens  of  Alexandria;  Pliny's  Natural  History;  Dioscori- 

2  From  the  statements  just  quoted  it  appears  that  a  certain  kind  of  bronze 
(an  alloy  of  copper  and  tin,  with  the  addition  perhaps  of  a  little  zinc)  was 
used  in  Assyria,  in  the  manufacture  of  surgical  knives,  as  early  as  during  the 
twenty-third  century  B.  C.  Dr.  Meyer-Steineg,  Professor  of  the  History  of 
Medicine  in  the  University  of  Jena,  Germany,  assures  the  writer  that  knives 
made  of  this  material  are  susceptible  of  being  given  as  keen  a  cutting  edge 


ORIENTAL  MEDICINE  17 

des;  the  Papyrus  Ebers;  the  Papyrus  Brugsch;  and  the 
Papyrus  Birch,  in  the  British  Museum.  Then,  in  addition 
to  these  sources,  there  are  the  inscriptions  found  in  recent 
times  on  the  walls  of  the  temples  and  the  pictures  painted 
on  the  wrappings  of  mummies,  from  both  of  which  consid- 
erable information  with  regard  to  various  therapeutic 
procedures  and  to  the  details  of  the  process  of  embalming 
Has  been  derived.  Some  of  this  information  extends  back 
to  about  3000  B.  C.  The  healing  art  was  at  that  time 
entirely  in  the  hands  of  the  temple  priests,  who  formed  an 
organized  body  with  a  sort  of  physician-in-chief  at  its  head. 
Two  of  these — Athotis  and  Tosorthos — attained  such  a  high 
standing  and  possessed  such  influence  that  they  were  chosen 
Kings  of  Egypt.  The  practice  of  obstetrics  was  entrusted 
to  the  care  of  women  who  had  been  trained  to  this  work  and 
who  acknowledged  the  authority  of  a  skilled  head-nurse  of 
their  own  sex.  The  patients  who  had  received  treatment 
for  their  ailments  at  one  or  other  of  the  temples  presented 
to  these  institutions  gifts  in  the  form  of  sculptured  or 
painted  representations  of  the  diseased  or  injured  parts 
of  the  body.  In  these  and  in  other  ways  medicine  and 
pharmacy  received  contributions  which  were  of  no  mean 
value.  Botanical  gardens  were  established  at  various 
places  in  Egypt  and  were  cultivated  with  care.  Chem- 
istry— a  name  which  derives  its  origin  from  a  word  in  the 
Egyptian  language — also  made  considerable  progress  as  a 
science.  On  the  other  hand,  the  knowledge  of  the  structure 
and  functions  of  the  different  parts  of  the  human  body 
was  very  imperfect  and  remained  unchanged  for  many 
centuries.  This  would  probably  not  have  been  the  case  if 
the  work  of  preparing  the  bodies  for  the  process  of 
embalming  had  not  been  entrusted  entirely  to  mere  menials, 
men  who  had  no  interest  in  anything  but  the  mechanical 
part  of  their  occupation. 

According  to  the  statement  of  Clemens  of  Alexandria' 

as  are  those  made  of  the  best  of  steel.  At  least  one  such  bronze  knife  may  be 
seen  in  the  collection  of  ancient  surgical  instruments,  votive  offerings,  etc., 
which  he  is  making  for  the  benefit  of  the  University. 

8  A  Christian  ecclesiastical  writer  who  lived  about  the  year  200  A.  D. 


18  GROWTH  OF  MEDICINE 

the  Egyptian  science  of  medicine  is  set  forth  in  the  last  six 
of  the  forty-two  hermetic  books,  which  were  composed, 
according  to  the  prevailing  belief,  by  the  god  Thot  or 
Thoiit  (=  Hermes  of  the  Greeks).  The  first  one  of  these 
six  books  is  devoted  to  the  anatomy  of  the  human  body,  the 
second  one  to  the  diseases  to  which  it  is  liable,  the  third  to 
surgery,  the  fourth  to  remedial  agents,  the  fifth  to  the 
diseases  of  the  eye,  and  the  sixth  to  diseases  of  women. 
As  to  the  remedial  agents,  Neuburger  says  that  it  has  not 
been  found  practicable  to  identify  more  than  a  very  few  of 
the  Egyptian  drugs  enumerated  by  Dioscorides.  Homer, 
who  wrote  at  least  five  hundred  years  B.  C,  has  something 
to  say  on  this  subject  in  the  Odyssey.*  His  words  are  as 
follows : — 

Such  drugs  Jove's  daughter  owned,  with  skill  prepar'd, 

And  of  prime  virtue,  by  the  wife  of  Thone, 

Aegyptian  Polydamna,  given  her. 

For  Aegypt  teems  with  drugs,  yielding  no  few 

Which,  mingled  with  the  drink,  are  good,  and  many 

Of  baneful  juice,  and  enemies  to  life. 

There  every  man  in  skill  medicinal 

Excels;  for  they  are  sons  of  Pason^  all. 

A  physician  of  the  present  age,  on  reading  the  histories 
of  the  ancient  Egyptians,  Greeks  and  other  oriental 
nations,  finds  it  almost  impossible  to  realize  that  many  of 
the  characters  designated  as  gods  and  goddesses,  possibly 
all  of  them,  were  not  mythological  persons,  as  they  would 
have  been  termed  only  a  few  years  ago,  but  real  human 
beings  like  ourselves.  Such,  for  example,  was  the  opinion 
of  Cicero  who,  when  asked  why  these  people  were  spoken 
of  as  gods,  gave  the  following  reply  :^  *'It  was  a  well- 
established  custom  among  the  ancients  to  deify  those  who 
had  rendered  to  their  fellow  men  important  services,  as 

4 Lines  285-292  of  Book  IV.  of  the  Earl  of  Derby's  translation,  first  pub- 
lished in  1864. 

5  Pason  is  the  same  as  Apollo,  who  was  believed  by  the  Greeks  to  have  been 
the  inventor  or  discoverer  of  the  art  of  medicine. 

•  See  Le  Clerc  's  Histoire  de  la  Medecine,  Amsterdam,  1723. 


ORIENTAL  MEDICINE  19 

Hercules,  Castor  and  Pollux,  Aesculapius,  Bacchus  and 
many  others  had  done.'*  And  I  find  that  those  modern 
authors  of  the  history  of  medicine  whose  works  I  have 
consulted,  are  quite  ready  to  accept  even  the  gods  called 
by  the  Egyptians  Osiris  (or  Serapis),  Isis,  and  Thoiit 
(or  Hermes)  as  genuine  historical  personages.  Such  a 
belief  receives  some  degree  of  confirmation  from  the 
following  inscriptions  which,  according  to  the  authority  of 
Le  Clerc,^  were  found  engraved  upon  two  columns  dis- 
covered in  the  city  of  Nyoa,  in  Arabia : — 

(On  the  first  column)  :  My  father  is  Cronos,  the  youngest  of 
all  the  gods.  I  am  King  Osiris,  who  have  visited  with  my  armies 
every  country  on  the  face  of  the  earth — the  remotest  inhabitable 
parts  of  India,  the  regions  lying  beneath  the  Bear,  the  neighbor- 
hood of  the  sources  of  the  Danube,  and  the  shores  of  the  Ocean. 
I  am  the  oldest  son  of  Cronos,  the  scion  of  a  fine  and  noble  race. 
I  am  related  to  the  day.  There  is  no  part  of  the  earth  which  I 
have  not  visited,  and  I  have  filled  the  entire  universe  with  my 
benefits.  (On  the  second  column)  :  I  am  Isis,  Queen  of  all  this 
country,  and  I  have  been  taught  by  Thoiit.  There  is  nobody  who 
has  the  power  to  loosen  what  I  shall  bind.  I  am  the  oldest  daughter 
of  Cronos,  the  youngest  of  the  gods.  I  am  the  wife  and  at  the  same 
time  the  sister  of  King  Osiris.  To  me  is  due  the  credit  of  having 
been  the  first  to  teach  men  agriculture.  I  am  the  mother  of  King 
Horus.  I  shine  in  the  dog-star.  It  is  I  who  built  the  city  of 
Bubastis.    Farewell,  Egypt,  my  native  land. 

The  discovery  of  the  art  of  medicine,  says  Le  Clerc,  was 
attributed  to  Osiris  and  Isis,  and  they  were  also  credited 
with  having  taught  it  to  Aesculapius. 

At  the  cities  of  On  (Heliopolis),  Sais,  Memphis  and 
Thebes  were  located  the  most  celebrated  of  the  Egyptian 
temples,  which  were  dedicated  not  merely  to  the  worship 
of  their  numerous  gods,  but  also  to  the  dissemination  of 
knowledge  of  various  kinds  and  to  the  care  of  the  sick  and 
maimed.  In  a  word,  they  were — like  the  Aesculapian 
temples  at  Trikka,  Epidaurus  and  Cos,  of  which  some 
account  will  be  given  farther  on — both  hospitals  for  the 

T  At  bottom  of  p.  15  of  his  Riatoire  de  la  Midecine. 


20  GROWTH  OF  MEDICINE 

treatment  of  disease  and  schools  for  the  training  of 
physicians.  The  chief  priest  of  the  temple  bore  also  the 
title  of  the  *' physician-in-chief , "  and  exercised  the  pre- 
rogatives of  a  chief  magistrate.  Under  this  system  medical 
knowledge  advanced  to  a  certain  stage  and  then  made  no 
further  progress.  The  preponderance  of  the  priestly  {i.e., 
the  superstitious)  influence  was  too  pronounced  to  permit 
anything  like  real  progress. 

The  papyrus  Ebers  makes  mention  of  a  number  of  dis- 
eases, and  among  them  the  following  may  be  noted :  abdomi- 
nal affections  (probably  dysentery),  intestinal  worms, 
inflammations  in  the  region  of  the  anus,  hemorrhoids, 
painful  disorders  at  the  pit  of  the  stomach,  diseases  of  the 
heart,  pains  in  the  head,  urinary  affections,  dyspepsia, 
swellings  in  the  region  of  the  neck,  angina,  a  form  of 
disease  of  the  liver,  about  thirty  different  affections  of  the 
eyes,  diseases  of  the  hair,  diseases  of  the  skin,  diseases  of 
women,  diseases  of  children,  affections  of  the  nose,  ears 
and  teeth,  tumors,  abscesses  and  ulcers. 

In  the  matter  of  diagnosis  the  Egyptian  physicians  not 
only  employed  inspection  and  palpation,  but  were  in  the 
habit  of  examining  the  urine.  A  statement  made  in  the 
papyrus  Ebers  is  good  ground  for  the  belief  that  they  also 
employed  auscultation  to  some  extent. 

Therapeutics  constituted  beyond  all  question  the  strong- 
est part  of  Egyptian  medicine.  As  might  be  expected  from 
the  strange  mixture  of  the  priest  and  the  medical  man  in 
every  physician,  the  remedial  measures  commonly  employed 
consisted  in  part  of  prayers  and  incantations,  and  in  part  of 
rational  procedures  and  the  use  of  drugs.  Among  the  latter 
class  of  remedies  the  following  deserve  to  be  mentioned: 
emetics,  cathartics  and  clysters.  Bloodletting,  sudorifics, 
diuretics  and  substances  which  cause  sneezing  were  also 
often  employed  in  Egypt.  To  produce  vomiting  the  favorite 
agents  were  the  copper  salts  and  oxymel  of  squills.  Castor 
oil  disguised  in  beer  was  given  as  an  aperient.  Pome- 
granate was  the  drug  preferred  for  the  expulsion  of  worms. 
Mandragora  and  opium  were  also  employed  as  remedies. 
Foreign  drugs  were  largely  imported  by  the  Phoenicians, 


ORIENTAL  MEDICINE  21 

and  in  their  successful  campaigns  against  Asiatic  nations 
the  Egyptians  learned  much  about  the  use  of  these  rarer 
remedies.  The  different  forms  in  which  the  Egyptians 
administered  their  remedies  included  potions,  electuaries, 
gums  to  be  chewed  but  not  swallowed,  gargles,  snuffs, 
inhalations,  salves,  plasters,  poultices,  injections,  supposi- 
tories, clysters  and  fumigations.  The  physicians,  in  their 
practice,  were  subjected  to  very  strict  rules  regarding  the 
amount  of  the  doses  to  be  given  and  the  manner  of  admin- 
istering the  different  remedies,  and  consequently  they 
received  no  encouragement  to  indulge  in  any  individuality 
of  action.  The  prescriptions  were  written  in  very  much 
the  same  manner  as  are  those  of  to-day;  that  is,  they 
contained  the  fundamental  or  important  drugs,  certain 
accessory  materials,  and  something  which  was  intended 
merely  to  correct  the  unpleasant  taste  of  the  mixture.  In 
comparison  with  those  commonly  written  at  a  somewhat 
later  period  these  ancient  prescriptions  were  of  a  very 
simple  character. 

Up  to  the  present  time  the  researches  of  the  archaeolo- 
gists have  thrown  comparatively  little  light  on  the  surgery 
of  the  ancient  Egyptians.  The  facts  already  ascertained, 
however,  are  sufficient  to  warrant  the  statement  that  they 
had  reached  a  degree  of  knowledge  and  skill  in  this  depart- 
ment of  medicine  well  in  advance  of  that  reached  by  any 
of  their  contemporaries.  They  performed  the  operations 
of  circumcision  and  castration,  and  they  removed  tumors, 
and  their  eye  surgeons  were  especially  renowned  for  the 
work  which  they  accomplished  in  their  special  department. 
Their  skill  in  manufacturing  surgical  instruments  is  amply 
revealed  in  the  specimens — instruments  for  cupping, 
knives,  hooks,  forceps  of  different  kinds,  metal  sounds  and 
probes,  etc. — ^which  have  been  dug  up  at  the  various  sites 
of  ancient  ruins.  They  must  also  have  possessed  consid- 
erable manual  skill,  for  without  it  they  could  not,  in 
embalming  a  corpse,  have  removed  the  entire  brain  from 
the  skull  with  a  long  hook,  by  way  of  the  nasal  passages, 
and  at  the  same  time  have  left  the  form  of  the  face 
undisturbed. 


22  GROWTH  OF  MEDICINE 

From  Joachim's  German  translation  of  the  papyrus 
Ebers,*  as  quoted  by  Neuburger,  I  copy  the  following 
passages : — 

If  thou  findest,  in  some  part  of  the  surface  of  a  patient's  body, 
a  tumor  due  to  a  collection  of  pus,  and  dost  observe  that  at  one 
well-defined  spot  it  rises  up  into  a  noticeable  prominence,  of 
rounded  form,  thou  should 'st  say  to  thyself:  This  is  a  collection 
of  pus,  which  is  forming  among  the  tissues ;  I  will  treat  the  disease 

with  the  knife If  thou  findest,  in  the  throat  of  a  patient, 

a  small  tumor  containing  pus,  and  dost  observe  that  it  presents 
at  one  point  a  well-defined  prominence  like  a  wart,  thou  may'st 
conclude  that  pus  is  collecting  at  this  point.  .....  If  thou  findest, 

in  a  patient's  throat,  a  fatty  growth  which  resembles  an  abscess, 
but  which  yields  a  peculiar  sensation  of  softness  under  the  pressure 
of  the  finger,  say  to  thyself:  this  man  has  a  fatty  tumor  in  his 
throat ;  I  will  treat  the  disease  with  the  knife,  but  at  the  same  time 
I  will  be  careful  to  avoid  the  blood-vessels. 

These  short  extracts  will  suffice  to  show  that  the  Egyptian 
physicians  of  that  early  period — at  least  1550  B.  C. — 
reasoned  about  pathological  lesions  in  very  much  the  same 
manner  as  a  physician  of  to-day  would  reason.  In  this 
same  ancient  papyrus,  however,  foolish  as  well  as  sensible 
statements  appear.  Thus,  for  example,  mention  is  made 
on  the  one  hand  of  the  fact  that,  in  order  to  give  a  certain 
remedy  to  an  infant,  it  is  sufficient  to  administer  it  to  the 
nurse  who  suckles  the  child  (a  proceeding  which  is  not 
uncommon  in  our  own  day) ;  and  then,  in  another  part  of 
the  text,  it  is  stated  that  ^*if,  on  the  day  of  its  birth,  the 
infant  does^  ^not  cry,  it  will  surely  live ;  but,  if  it  says  *  ba,  * 
it  will  die.  'J 

In  matters  relating  to  personal  hygiene  the  ancient 
Egyptians  often  displayed  a  remarkable  degree  of  common 
sense.  They  maintained,  for  example,  that  the  majority 
of  diseases  are  due  to  the  taking  of  food  in  excessive 
quantity ;  and,  in  harmony  with  this  belief,  they  introduced 
the  custom  of  devoting  three  days  out  of  every  thirty  to 
the  taking  of  emetics  and  clysters.    Perhaps  it  was  to  this 

8  Papyros  Ebers,  aus  dem  Aegyptischen  zum  ersten  Male  vollstandig  uber- 
setzt  von  H.  Joachim,  Berlin,  1890. 


ORIENTAL  MEDICINE  23 

custom  that  they  owed  their  good  health, — a  fact  to  which 
both  Herodotus  and  Diodorus  testify.  In  principle  this 
practice  agrees  with  that  adopted  by  modern  physicians, 
who  omit  the  emetics  and  substitute  for  the  clysters  the 
drinking  of  certain  mineral  waters  during  a  limited  period 
of  the  summer  season  and  under  the  very  agreeable 
surroundings  of  a  comfortable  hotel  at  Carlsbad,  Ems, 
Wiesbaden  or  Saratoga.  While  the  monthly  plan  of 
purging  the  system  of  harmful  elements  must  certainly 
have  been  the  more  effective  of  the  two,  it  cannot  for  a 
moment  be  doubted  that  exceedingly  few  moderns  would 
be  willing  to  subject  themselves  to  such  a  regime. 

In  still  other  ways  the  ancient  Egyptians  displayed  a 
most  intelligent  respect  for  every  measure  that  tended  to 
promote  the  general  health  of  the  community.  They  took 
care,  for  example,  to  prevent  the  entrance  of  decomposing 
materials  into  the  soil  and  the  ground  water ;  priests  skilled 
in  work  of  this  character  made  careful  inspections  of  all 
meats  that  were  to  be  used  for  food ;  stress  was  laid  upon 
the  importance  of  keeping  the  dwelling  houses  clean;  the 
people  were  taught  the  value  of  bathing  the  body  frequently, 
of  cultivating  gynmastic  exercises,  of  clothing  themselves 
suitably,  and  of  employing  the  right  sort  of  diet.  At  a  still 
later  period  of  their  history  they  adopted  the  custom  of 
drinking  only  water  that  had  been  either  boiled  or  filtered. 
A  particular  kind  of  beer,  the  gift  of  their  first  king,  Osiris, 
was  the  favorite  beverage  of  the  people.  It  was  made  from 
barley  and  doubtless  possessed  intoxicating  properties,  as 
is  suggested  by  one  of  the  papyrus  texts  in  which  the 
following  charge  is  brought  against  a  student:  **Thou 
hast  abandoned  thy  books  and  art  devoting  thyself  to  idle 
pleasures,  going  from  one  beer-house  to  another.  Thou 
smellest  so  strongly  of  beer  that  men  avoid  thee." 

A  large  proportion  of  the  sources  of  information  regard- 
ing the  medicine  of  the  ancient  Egyptians  have  been 
brought  to  light  during  recent  years,  but  so  many  gaps  in 
the  series  still  remain  unfilled  that  it  is  not  possible  to 
furnish  more  than  a  disconnected  and  very  imperfect 
account.    Archaeological  investigations,  however,  are  being 


24  GROWTH  OF  MEDICINE 

conducted  with  vigor  and  new  discoveries  are  reported 
almost  every  month.  There  are  therefore  good  reasons  for 
hoping  that,  in  the  course  of  the  next  few  years,  much 
additional  light  will  be  shed  on  the  mode  of  life  and 
accomplishments  of  these  pioneers  of  civilization,  who, 
before  they  passed  out  of  history,  succeeded  in  attaining 
the  highest  degree  of  cultivation  in  the  science  and  art  of 
medicine  that  had  up  to  that  time  been  attained  by  any 
other  nation.  One  thing  is  certain,  says  Neuburger,  they 
exerted  a  powerful  influence  upon  the  beginning  of  medicine 
in  Greece  and  upon  the  social  hygiene  of  the  Jewish  people, 
and  therefore  upon  the  human  race  at  large. 


CHAPTER  III 
ORIENTAL  MEDICINE  (Continued) 

The  Medicine  of  the  Ancient  Persians. — ^After  Cyrus  the 
Great  had  put  an  end  to  Babylon  as  a  power  among  the 
nations  the  Persians  became  the  leaders  in  all  the  affairs 
not  merely  of  Asia  Minor  but  also  of  the  entire  country 
from  India  to  the  shores  of  the  Mediterranean;  in  fact, 
they  eventually  also  gained  control  of  the  land  of  the 
Pharaohs.  Notwithstanding  the  completeness  of  the 
political  power  which  they  possessed  over  these  conquered 
races,  they  permitted  them  to  retain  their  respective 
religions  and  even  their  individual  languages ;  as  evidence 
of  the  correctness  of  which  last  statement  the  modern 
discovery  of  inscriptions  written  in  the  three  principal 
tongues  may  be  mentioned.  The  remarkable  degree  of 
general  culture  which  existed  at  Babylon  at  the  time  of  the 
Persian  conquest,  and  which  the  Sumerians  and  Semites 
had  originally  introduced,  was  left  undisturbed  by  the 
political  change. 

So  far  as  we  possess  any  knowledge  regarding  the 
medicine  of  the  ancient  Persians,  this  information  has  been 
derived,  according  to  Neuburger,  from  the  Zend-Avesta — 
one  of  the  ancient  religious  writings  preserved  by  the 
Parsees.  It  furnishes  comparatively  few  facts  of  special 
interest  to  physicians.  In  the  main,  the  practice  of  medi- 
cine must  have  differed  very  little  from  that  employed 
by  the  earliest  Babylonian  physicians,  and  briefly  described 
on  pages  11-16.  There  are  one  or  two  additional 
matters,  however,  which  deserve  to  be  mentioned  here.  It 
was  maintained,  for  example,  that  the  touching  of  a  corpse 
produced  a  special  contamination,  a  belief  which  interfered 
most  seriously  with  the  study  of  anatomy,  and  therefore 


26  GROWTH  OF  MEDICINE 

prevented  any  real  advance  in  medical  knowledge.  Then, 
again,  the  ancient  Persians  appear  to  have  taken  compara- 
tively little  interest  in  surgery,  for  it  is  said  that  King 
Darius  I.  was  obliged,  when  he  needed  treatment  for  a 
badly  sprained  ankle,  to  send  for  a  Greek  physician. 
Finally,  there  may  be  found  in  Herodotus  the  following 
statement,  which  shows  that  the  Persians  had  learned 
something  of  value,  in  practical  hygiene,  from  their 
neighbors,  the  Egyptians: — 

The  Great  King  (Cyrus),  when  he  goes  to  the  wars,  is  always 
supplied  with  provisions  carefully  prepared  at  home,  and  with 
cattle  of  his  own.  "Water,  too,  from  the  river  Choaspes,  which  flows 
by  Susa,  is  taken  with  him  for  his  drink,  as  that  is  the  only  water 
which  the  kings  of  Persia  taste.  "Wherever  he  travels,  he  is 
attended  by  a  number  of  four-wheeled  cars  drawn  by  mules,  in 
which  the  Choaspes  water,  ready  boiled  for  use,  and  stored  in 
flagons  of  silver,  is  moved  with  him  from  place  to  place.^ 

Neuburger  makes  the  remark  that  the  ancient  Persians 
are  entitled  to  the  gratitude  of  later  generations  for  the 
valuable  service  which  they  rendered  the  science  of  medi- 
cine, inasmuch  as,  during  the  dynasty  of  the  Sassanide 
princes  (fifth  century  A.  D.)  and  at  a  time  when  European 
culture  was  hastening  to  its  destruction,  they  gave  shelter 
both  to  classical  culture  in  general  and  to  the  medical 
knowledge  of  the  Greeks,  and  then  afterward  handed  it 
over  to  the  conquering  Arabs,  who  passed  it  on  to  our 
forefathers. 

The  Medicine  of  the  Old  Testament. — There  are  no 
medical  writings  which  give  any  information  concerning 
the  science  and  art  of  medicine  as  possessed  by  the  ancient 
Israelites,  but  the  Bible  contains  a  number  of  passages  that 
refer  to  matters  which  belong  in  the  domain  of  medicine, 
and  more  particularly  in  that  of  social  hygiene.  The  mosaic 
laws  were  framed  with  a  view  to  the  good  of  the  Jewish 
people  as  a  whole,  and  were  directed  to  such  matters  as 
the  prevention  and  suppression  of  epidemic  diseases,  the 
combating  venereal  affections  and  prostitution,  the  care 

1  Book  I.,  p.  96,  of  George  Eawlinson  's  translation. 


ORIENTAL  MEDICINE  27 

of  the  skin,  the  systematizing  of  work,  the  regulation  of 
sexual  life,  the  intellectual  cultivation  of  the  race,  the 
provision  of  suitable  clothing,  dwellings  and  food,  the  use 
of  baths,  etc.  Many  of  these  laws — like  those,  for  example, 
which  prescribe  rest  on  the  Sabbath  day,  circumcision, 
abstinence  from  eating  the  flesh  of  the  pig,  the  isolation  of 
persons  affected  with  leprosy,  the  observation  of  hygienic 
rules  in  camp  life,  etc. — testify  to  a  remarkably  high  degree 
of  the  power  to  reason  correctly;  and,  when  considered  in 
the  light  of  modern  science,  they  seem  to  justify  the  pre- 
diction made  in  Deuteronomy  iv.,  6.  A  similar  prediction 
(supposed  to  be  spoken  by  God  from  Mount  Sinai)  is  made 
in  Exodus  xix.,  6:  ''And  ye  shall  be  unto  me  a  kingdom 
of  priests,  and  an  holy  nation. ' '  That  a  large  part  of  the 
credit  given  to  Moses  for  the  wisdom  displayed  in  these 
sanitary  laws  really  belongs  to  the  Egyptians  is  shown  by 
the  text  of  Acts  vii.,  22:  ''And  Moses  was  learned  in  all 
the  wisdom  of  the  Egyptians,  and  was  mighty  in  words  and 
in  deeds." 

As  regards  the  manner  in  which  the  Israelites  treated 
the  diseases  which  afflicted  them  the  Bible  furnishes  ample 
proof  of  the  fact  that  they  placed  their  chief  reliance  upon 
prayers,  sacrifices,  and  offerings  at  their  temples,  and 
made  comparatively  small  use  of  medicinal  agents,  dietetic 
measures,  and  external  applications.  The  favorable  effect 
of  David 's  harp-playing  upon  the  melancholia  of  King  Saul 
furnishes  the  only  instance,  to  be  found  in  the  Bible,  of  the 
curative  value  of  music  in  certain  mental  disorders. 

The  story  of  Naaman  (2  Kings  v.)  deserves  to  be 
mentioned  briefly  here.  He  was  captain  of  the  host  of  the 
King  of  Syria  (about  894  B.  C.)  and  a  man  of  valor,  highly 
esteemed  by  his  master,  but  he  was — according  to  the  Bible 
statement — a  leper.  Learning  casually  that  there  was  in 
Samaria  a  prophet  who  might  be  able  to  cure  his  disease, 
he  put  a  large  sum  of  money  into  his  sack  and  departed  for 
that  country.  "So  Naaman  came  with  his  horses  and  with 
his  chariot,  and  stood  at  the  door  of  the  house  of  Elisha. 
And  Elisha  sent  a  messenger  unto  him,  saying.  Go  and 
wash  in  Jordan  seven  times,  and  thy  flesh  shall  come  again 


y~ 


28  GROWTH  OF  MEDICINE 

to  thee,  and  thou  shalt  be  clean."  Naaman,  at  first  much 
displeased  with  the  advice  given  to  him  by  Elisha,  and 
especially  by  the  very  informal  manner  in  which  it  had 
been  communicated  to  him,  finally  decided  to  follow  the 
prophet's  instructions.    *^Then  went  he  down,  and  dipped 

himself  seven  times  in  Jordan, and  his  flesh  came 

again  like  unto  the  flesh  of  a  little  child,  and  he  was  clean. 

And  he  returned  to  the  man  of  God, and  came,  and 

stood  before  him;  and  he  said.  Behold,  now  I  know  that 
there  is  no  God  in  all  the  earth,  but  in  Israel:  now  there- 
fore, I  pray  thee,  take  a  blessing  of  thy  servant."  Elisha, 
however,  refused  persistently  to  accept  any  reward  for  the 
advice  which  he  had  given.  He  simply  said  to  Naaman: 
**Go  in  peace."  Before  he  departed,  however,  Naaman 
expressed  to  Elisha  the  hope  that  he  would  be  pardoned 
if  he  yielded  to  the  necessity  of  bowing  down  to  the  god 
Rimmon  on  certain  occasions — as,  for  example,  when  he 
accompanied  his  master,  the  king,  on  his  visits  to  the 
temple  of  that  god  for  the  purposes  of  worship.  From  the 
evidence  furnished  by  this  account,  as  given  in  the  Old 
Testament,  it  is  fair  to  assume  that  both  Naaman  and  the 
writer  of  the  book  of  Kings  believed  that  the  cure  had  been 
effected  by  supernatural  means.  The  modern  physician, 
however,  is  not  ready  to  accept  such  an  interpretation  of 
the  manner  in  which  Naaman 's  cure  was  effected,  but 
prefers  to  believe  that  the  supposed  leprosy  was  in  reality 
some  curable  form  of  skin  disease  which  to  the  unprofes- 
sional eye  appeared  like  the  other  malady.  It  might,  for 
example,  have  been  an  aggravated  general  eczema,  depend- 
ent upon  such  excesses  of  eating  and  drinking  as  a  wealthy 
captain  of  the  king's  host  would  be  likely  to  indulge  in. 
And  if  this  supposition  is  correct,  one  cannot  but  admire 
the  great  practical  wisdom  of  Elisha  in  advising  Naaman 
to  take  seven  baths — one  a  day  presumably — in  the  river 
Jordan,  a  spot  so  far  removed  from  his  home  that  it  would 
scarcely  be  possible  for  him  to  obtain  any  but  the  simplest 
kind  of  diet  during  this  comparatively  long  period  of  time. 
An  interesting  case  of  snake-bite  is  briefly  related  in 
Acts  xxviii.,  3-6.    It  is  stated  that  ''when  Paul  (after  being 


ORIENTAL  MEDICINE  29 

shipwrecked  on  the  Island  of  Melita)  had  gathered  a  bundle 
of  sticks,  and  laid  them  on  the  fire,  there  came  a  viper  out 
of  the  heat,  and  fastened  on  his  hand.  And  when  the 
barbarians  saw  the  venomous  beast  hang  on  his  hand,  they 
said  among  themselves,  No  doubt  this  man  is  a  murderer, 
whom,  though  he  hath  escaped  the  sea,  yet  vengeance 
suffereth  not  to  live.  And  he  shook  off  the  beast  into  the 
fire,  and  felt  no  harm.  Howbeit  they  looked  when  he  should 
have  swollen,  or  fallen  down  dead  suddenly :  but  after  they 
had  looked  a  great  while,  and  saw  no  harm  come  to  him, 
they  changed  their  minds,  and  said  that  he  was  a  god.'* 
This  narrative  is  interesting  in  several  respects,  but  there 
is  one  feature  that  deserves  to  receive  special  mention,  viz., 
the  fact  that  Paul  experienced  no  harm  from  the  bite  of  a 
poisonous  serpent — a  wound  which  frequently  proves  fatal. 
Inasmuch  as  the  account  distinctly  states  that  the  reptile 
** fastened  on  his  hand"  and  that  *Hhe  barbarians  saw  the 
venomous  beast  hang  on  his  hand,"  the  conclusion  is  war- 
ranted that  one  or  both  of  the  creature 's  fangs  had  entered 
the  hand  by  a  curving  route,  and  probably  in  such  a  manner 
that  the  free  end  of  each  fang,  from  which  the  poison  is 
ejected,  passed  completely  through  the  skin  from  within 
outward.  When  the  bite  of  a  poisonous  snake  is  of  a 
character  such  as  I  have  just  described, — and  not  a  few 
of  them  have  this  character, — only  a  very  small  quantity 
of  the  venom  is  lodged  in  the  subcutaneous  tissues,  where 
the  larger  blood-  and  lymph-channels  lie,  and  as  a  conse- 
quence the  person  bitten  escapes  serious  harm.  On  the 
other  hand,  when  the  fangs  enter  the  flesh  in  a  less  decidedly 
curving  direction,  thus  permitting  a  greater  quantity  of 
the  venom  to  reach  and  remain  in  the  deep-lying  tissues, 
serious  or  even  fatal  results  may  be  anticipated.  The  point, 
then,  which  I  desire  to  make  is  simply  this:  Paul's  escape 
from  death  in  this  instance  may  perfectly  well  be  ascribed 
to  natural  causes. 

The  Israelites,  at  a  certain  stage  of  their  history,  appear 
to  have  completely  divorced  the  practice  of  medicine  from 
the  priestly  function.  In  one  place,  for  example,  it  is  stated 
that  King  Asa  sought  relief  from  his  ailment,  not  from 


30  GROWTH  OF  MEDICINE 

Jehovah,  but  from  the  physicians.  Jeremiah  expresses 
astonishment  that  not  a  single  physician  is  to  be  found  in 
Gilead.  May  this  not  be  interpreted  as  signifying  that 
regularly  established  physicians  were  at  that  time  (595 
B.  C.)  to  be  found  in  some  parts  of  Palestine?  And,  at  a 
much  earlier  period  (1500  B.  C),  Job  calls  his  friends 
''physicians  of  no  value"  (Job  xiiL,  iv.).  From  these  and 
a  number  of  other  statements  in  the  Bible  it  seems  per- 
missible to  believe  that,  at  a  very  early  period  of  history, 
the  Jewish  physicians  occupied  an  entirely  independent 
position. 

It  would  doubtless  appear  strange  to  most  readers  of 
this  brief  sketch  of  the  history  of  medicine  if  some  refer- 
ence were  not  made  in  this  place  to  Luke,  the  author  of  the 
gospel  which  bears  his  name  and  of  the  Acts  of  the 
Apostles,  and  who  was  also  the  companion  of  Paul  on  his 
journey  to  Rome  and  during  a  portion  of  the  latter 's  stay 
in  that  city.  Luke  was  a  native  of  Antioch,  in  Syria,  and 
not  a  Jew.  He  was  a  physician  and  tradition  says  that  he 
was  also  a  painter.  It  is  not  known  where  he  received  his 
medical  training,  but  it  is  not  at  all  unlikely  that  he  studied 
at  Alexandria,  in  Egypt,  where  the  greatest  facilities  for 
such  training,  obtainable  at  that  period,  were  to  be  found. 
His  style  of  writing  shows  plainly  that  he  was  a  man  of 
considerable  cultivation  and  endowed  with  a  clear  and 
logical  mind ;  and  if  he  had  not  possessed  a  genial  person- 
ality he  would  hardly  have  been  known  as  "the  beloved 
physician";  nor  could  any  other  motive  but  those  of  loyal, 
self-sacrificing  friendship  for  his  friend,  and  a  desire  to 
promote  the  cause  of  Christianity,  have  led  him  to  share 
with  Paul  the  dangers  and  discomforts  of  the  journey  to 
Rome. 

The  Medicine  of  India,  China  and  Japan. — It  would  be 
too  much  of  a  departure  from  the  plan  which  is  being 
followed  in  the  writing  of  this  history  to  attempt  to 
describe,  even  in  the  briefest  manner,  the  mode  of  develop- 
ment of  the  science  and  art  of  medicine  in  India,  China 
and  Japan.  Unquestionably  the  earlier  physicians  of 
these    countries    made    many    valuable    contributions    to 


ORIENTAL  MEDICINE  31 

medical  knowledge,  but  they  were  made  at  such  a  period 
of  time,  or  under  such  conditions,  that  they  could  not  have 
exerted  an  appreciable  influence  upon  the  development  of 
medicine  in  ancient  Greece, — certainly  no  such  influence  as 
was  exerted  by  Assyria  and  Persia,  and  especially  by 
Egypt.  It  therefore  seems  permissible  to  speak  of  the 
medicine  of  these  more  remote  countries  only  incidentally, 
and  not  as  an  integral  part  of  the  series  of  centres  of 
learning  which  made  the  medicine  of  ancient  Greece  the 
direct  ancestor — if  I  may  use  such  a  term — of  European 
medicine.^  In  conformity  with  this  idea  it  will  be  well  to 
mention  here  briefly  a  few  of  the  more  important  facts 
relating  to  the  achievements  of  the  physicians  of  the  three 
countries  named. 

The  most  celebrated  medical  authors  in  India  were 
Caraka,  Siisruta  and  Vagbhata — *'The  ancient  trinity," 
as  they  were  called.  Caraka  probably  lived  during  the 
early  part  of  the  Christian  era,  Susruta  during  the  fifth 
century,  and  Vagbhata  not  later  than  during  the  seventh 
century  A.  D.  It  is  apparent,  therefore,  that  none  of  the 
treatises  written  by  these  authors  could  have  exerted  the 
slightest  influence  upon  the  growth  of  medical  knowledge 
in  ancient  Greece. 

The  crudeness  of  many  of  the  conceptions  held  by  these 
Hindu  physicians  concerning  pathology  is  revealed  in  the 
following  definition :  ' '  Health  is  the  expression  of  the 
normal  composition  of  the  three  elementary  substances 
(air,  mucus  and  bile)  which  play  a  vital  part  in  the 
machinery  of  the  human  body,  and  it  is  also  dependent 
upon  the  existence  of  normal  quantitative  relations  between 
these  three  substances;  and  when  the  latter  are  damaged, 
or  when  they  are  abnormally  increased  or  diminished,  then 
disease  of  one  kind  or  another  makes  its  appearance.'" 

2  Neuburger  speaks  of  the  growth  of  medical  knowledge  in  India  as  a 
development  that  ran  parallel  with  that  of  ancient  Greece. 

3  From  Neuburger. — Equally  crude  are  their  ideas  respecting  the  causes  of 
disease,  as  shown  by  the  following  items  selected  from  quite  a  long  list  of 
etiological  factors:  errors  in  diet  and  in  the  habits  of  life,  climatic  influences, 
psychic  factors,  heredity,  poison,  supernatural  influences  like  the  anger  of  the 


32  GROWTH  OF  MEDICINE 

Great  stress  was  laid  by  the  physicians  as  well  as  by  the 
priests  of  ancient  India  upon  the  observance  of  very 
elaborate  rules  respecting  the  care  of  the  person  while  in 
health  and,  very  naturally,  when  a  patient  became  ill  the 
physician  in  charge  paid  quite  as  much  attention  to  the 
employment  of  hygienic  and  dietetic  measures  in  effecting 
the  desired  cure  as  to  the  administering  of  drugs. 

The  list  of  the  commonly  employed  hygienic  measures  is 
too  long  for  reproduction  in  its  entirety  in  this  brief  sketch, 
but  an  enumeration  of  some  of  the  more  important  items 
may  prove  interesting.  In  estimating  the  value  of  these 
rules  the  reader  should  bear  in  mind  that  they  were 
intended  for  people  living  in  a  hot  climate.  Daily  bathing 
heads  the  list.  Then  follow:  regulation  of  the  bowels; 
rubbing  the  teeth  with  fresh  twigs  of  certain  trees  which 
possess  astringent  properties,  and  also  brushing  them  twice 
a  day ;  rinsing  the  mouth  with  appropriate  washes ;  rubbing 
the  eyes  mth  salves;  anointing  the  body  with  perfumed 
oils;  cutting  the  nails  every  five  days,  etc.  Two  meals  a 
day  were  prescribed — the  first  one  between  nine  in  the 
morning  and  noon,  and  the  second  between  seven  and  ten 
in  the  evening.  * '  Only  a  moderate  amount  of  water  should 
be  drunk  during  the  meal ;  drinking  water  at  the  beginning 
of  a  meal  delays  digestion,  while  a  copious  draught  at  the 
end  produces  obesity.  After  the  meal  the  mouth  should  be 
carefully  cleansed  and  a  short  walk  should  be  taken." 
Among  the  more  important  articles  of  food  the  following 
deserve  to  be  mentioned:  rice,   ripe  fruit,   the  ordinary 

gods,  the  evil  powers  of  demons,  etc.  For  purposes  of  diagnosis  the  earlier 
Indian  physicians  utilized  not  only  inspection,  palpation  and  auscultation,  but 
also  the  senses  of  taste  and  smell.  They  noted  the  losses  and  increases  in  the 
weight  of  the  body,  changes  in  the  appearance  of  the  skin,  the  tongue  and  the 
excretions,  alterations  in  the  configuration  of  the  body,  the  form  and  other 
characteristics  of  swellings,  etc.  They  also  noted  changes  in  the  patient's 
voice,  in  the  character  of  the  breathing,  in  the  noises  accompanying  movements 
of  the  joints  and  the  twistings  of  the  intestines.  The  crepitus  caused  by  the 
rubbing  together  of  the  roughened  ends  of  a  fractured  bone  did  not  escape 
their  notice.  At  a  later  period,  doubtless  through  the  influence  of  the  teachings 
of  foreign  physicians,  they  attached  great  importance  to  the  examination 
of  the  pulse. 


ORIENTAL  MEDICINE  33 

vegetables,  ginger,  garlic,  salt,  milk,  oil,  melted  butter, 
honey  and  sugar  cane.  If  meat  is  eaten,  preference  should 
be  given  to  venison,  wild  fowl  and  the  flesh  of  the  buffalo. 
The  meat  of  the  pig,  and  beef,  as  well  as  fish,  are  less 
conducive  to  health.  Gymnastic  exercises  in  moderation 
are  beneficial.  Sleep  should  be  indulged  in  during  the  day 
only  after  some  specially  severe  exercise ;  at  night  it  should 
not  be  extended  beyond  one  hour  before  sunrise.  Bathing 
immediately  after  eating  is  harmful,  and  it  is  not  to  be 
indulged  in  when  one  is  affected  with  a  cold,  with  a  high 
fever,  with  diarrhoea,  or  with  some  disease  of  the  eyes 
or  ears.  A  hot  bath  or  washing  with  warm  water  may  be 
beneficial  for  the  lower  half  of  the  body,  but  for  the  upper 
half  it  is  harmful.  Sea  bathing  and  cold  baths  (preferably 
in  the  river  Ganges)  are  beneficial.  The  clothing  worn 
should  be  clean ;  soiled  garments  are  likely  to  produce  skin 
diseases.  It  is  advisable  to  wear  shoes,  and  an  umbrella 
or  a  staff  should  be  carried.  The  wearing  of  garlands, 
finery,  and  jewels  increases  the  vital  powers  and  keeps 
away  evil  spirits.  The  following  are  good  measures  to 
adopt  for  the  preservation  of  health:  an  emetic  once  a 
week;  a  laxative  once  a  month;  and  a  bloodletting  twice 
a  year.  All  the  measures  enumerated  above  were  subject 
to  modification  according  to  changes  in  the  season,  the 
locality,  the  weather,  and  various  other  circumstances. 

In  harmony  with  the  extraordinary  fruitfulness  of  the 
land  the  pharmacopoeia  of  India  is  very  rich.  It  is  a 
remarkable  fact  that  not  one  of  the  nupaerous  drugs 
mentioned  in  the  official  list  is  of  European  origin.  The 
great  majority  of  them  belong  to  the  vegetable  kingdom; 
Caraka  stating  that  he  knew  of  500  plants  that  possessed 
remedial  virtues,  while  Siisruta  placed  the  number  at  760. 
Then,  too,  the  list  contains  a  goodly  number  of  drugs  which 
belong,  some  to  the  animal  and  others  to  the  mineral  king- 
dom. It  appears  that  the  physicians  of  India  began  using 
mineral  substances,  both  externally  and  internally,  at  a 
very  early  period  of  their  history.  Among  such  substances 
the  following  may  be  mentioned:  sulphate  of  copper, 
sulphate  of  iron,  sulphate  of  lead,  oxide  of  lead,  sulphur. 


34  GROWTH  OF  MEDICINE 

arsenic,  borax,  alum,  potash,  chloride  of  ammonium,  gold, 
precious  stones  of  different  kinds,  etc.  The  people  of  India 
were  skilled  in  chemical  and  pharmaceutical  work.  The 
drugs  were  prepared  by  them  in  a  great  variety  of  ways — 
as,  for  instance,  extracts  of  the  juices  of  plants,  infusions, 
decoctions,  electuaries,  mixtures,  syrups,  pills,  pastes, 
powders,  suppositories,  collyria,  salves,  etc.  Practicing 
physicians  carried  with  them  a  sort  of  portable  medicine 
chest,  and  they  often  collected,  themselves,  the  medicinal 
plants  which  they  required.  Susruta  gives  instructions  as 
to  the  spots  where  certain  plants  are  most  likely  to  be 
found,  and  as  to  the  seasons  when  they  should  be  gathered. 
Charlatanry  and  mysticism  often  played  a  part  in  this 
business.  Thus,  it  was  maintained  that  drugs  collected  and 
prepared  by  persons  other  than  physicians  did  not  produce 
the  desired  effects.  The  fact  that  cosmetics  (especially 
hair  dyes),  ''elixirs  of  life,"  aphrodisiacs,  poisons  and 
antidotes  for  poisons,  occupy  the  most  prominent  place  in 
the  list  of  pharmaceutic  preparations  sold,  casts  a  glaring 
ray  of  light,  as  Neuburger  states,  on  the  degree  of  culture 
among  the  people  of  ancient  India. 

The  list  of  separate  maladies  recognized  by  the  physi- 
cians of  the  latter  country  is  inordinately  long.  There 
were  26  kinds  of  fevers,  13  species  of  swellings  of  the  lower 
abdomen,  20  different  diseases  due  to  worms,  20  kinds  of 
urinary  diseases,  8  varieties  of  strangury,  5  kinds  of 
jaundice,  5  varieties  of  cough  or  asthma,  18  kinds  of 
''leprosy,"  6  kinds  of  abscesses,  76  different  eye  diseases, 
28  affections  of  the  ear,  65  disorders  of  the  mouth,  31  nasal 
affections,  18  diseases  of  the  throat,  a  large  number  of 
mental  disorders,  etc.  It  seems  scarcely  necessary  to 
remark  that  these  so-called  diseases  were  in  reality  only 
groups  of  certain  types  of  loosely  related  symptoms.  The 
term  "leprosy,"  for  example,  included,  besides  the  disease 
which  modern  physicians  call  by  that  name,  a  number  of 
different  affections  of  the  skin.  It  is  worth  noting  here 
that  diabetes  mellitus,  which  is  one  of  the  twenty  different 
kinds  of  urinary  diseases  enumerated  in  the  classified  list 
mentioned  above,  was  first  described  by  the  physicians  of 


ORIENTAL  MEDICINE  35 

India,  whose  attention  was  directed  to  the  disorder  by 
observing  that  flies  and  other  insects  were  attracted  to  the 
urine  of  these  patients  by  reason  of  its  sweetness.  It  is 
also  an  interesting  fact  that  occasionally  these  physicians, 
who,  beyond  a  doubt,  were  keen  observers  of  symptoms, 
paid  some  attention  to  the  anatomical  features  of  the 
individual  cases.  Thus,  it  is  stated  that  the  particular 
form  of  swelling  of  the  lower  abdomen,  to  which  they 
applied  the  name  ''splenic  belly,"  is  dependent  upon  *'an 
enlarged  spleen  which  distends  the  left  side,  is  as  hard  as 
a  stone,  and  is  arched  like  the  back  of  a  turtle";  whereas 
they  spoke  of  *'an  enlargement  of  the  liver"  when  very 
much  the  same  conditions  were  observed  on  the  right  side 
of  the  abdomen.  The  accuracy  of  their  clinical  observations 
is  particularly  noticeable  in  their  accounts  of  cases  of 
consumption,  apoplexy,  epilepsy,  hemicrariia,  tetanus, 
rheumatism,  venereal  diseases,  some  affections  of  the  skin, 
and  insanity.  It  was  in  their  surgical  technique,  however, 
that  the  physicians  of  ancient  India  were  distinguished 
above  all  their  brethren  of  the  neighboring  oriental 
countries,  and  this  superiority  they  maintained  for  a  very 
long  time.  Among  the  operations  which  they  performed 
the  following  may  be  mentioned :  they  removed  tumors  by 
excising  them,  they  opened  abscesses  by  the  use  of  the 
knife,  they  employed  scarifications  (in  inflanmiations  of 
the  throat)  and  made  punctures  (in  hydrocele  and  ascites), 
they  passed  probes  into  fistulae,  they  extracted  foreign 
bodies,  and  they  employed  needles  armed  with  hairs  taken 
from  the  horse's  tail  or  with  thread  composed  of  flax  or 
hemp.  According  to  Susruta  their  stock  of  instruments 
was  composed  of  101  blunt  and  20  cutting  instruments. 
Among  those  which  were  blunt  there  were  forceps  of 
different  sizes  and  forms,  hooks,  tubes,  probes  or  sounds, 
catheters,  bougies,  etc.  They  made  use  of  the  magnet  for 
drawing  out  foreign  bodies  of  iron,  and  they  applied  cups 
for  therapeutic  purposes.  Their  cutting  instruments  con- 
sisted of  knives,  bistouris,  lancets,  scissors,  trochars, 
needles,  etc.  Steel  was  the  metal  of  which  they  were  made ; 
for  the  people  of  India  learned  at  a  very  early  period  how 


36  GROWTH  OF  MEDICINE 

to  make  steel.  In  suitable  cases  cauterization,  either  with 
the  actual  cautery  or  with  caustic  potash,  was  a  favorite 
method  of  treatment  with  the  surgeons  of  ancient  India. 
"Burning  with  the  heated  iron,"  they  taught,  ''is  more 
effective  than  cauterization  with  potash,  inasmuch  as  it 
permanently  cures  diseases  which  may  not  be  cured  by 
either  drugs,  surgical  instruments,  or  chemical  cauterizing 
agents."  In  cases  of  enlargement  of  the  spleen  they 
plunged  red-hot  needles  into  the  parenchyma  of  the  organ, 
presumably  through  the  skin  and  other  overlying  tissues. 
There  were  fourteen  different  kinds  of  surgical  dressings ; 
cotton,  woolen,  linen  and  silk  being  the  materials  used  for 
bandages,  and  strips  of  bamboo  or  some  other  wood  for 
splints.  When  the  conditions  permitted  such  a  proceeding, 
it  was  customary  to  sew  up  wounds  of  the  head,  face  and 
windpipe.  Furthermore,  it  was  the  rule  to  perform  all 
surgical  operations  at  a  time  when  the  constellations  were 
favorable.  Religious  ceremonies  were  performed  both 
before  the  operation  and  after  it  was  completed,  and  it  was 
also  considered  necessary  that  the  operator  should  face 
the  west  and  the  patient  the  east.  Intoxication  was 
employed  as  a  means  of  securing  narcosis.  Owing  to  their 
scrupulous  cleanliness  and  the  minute  attention  which  they 
paid  to  details,  the  surgeons  of  ancient  India  obtained  for 
a  long  time  a  much  higher  degree  of  success  than  did  the 
surgeons  of  other  oriental  nations.  At  the  same  time  they 
were  not  lacking  in  that  degree  of  boldness  which  enables 
an  operator — in  critical  cases  which  probably  without  such 
prompt  and  radical  action  would  terminate  fatally — to  save 
life.  For  example,  they  did  not  hesitate  to  open  the 
abdominal  cavity  and  to  sew  up  a  wound  in  the  intestines ; 
they  cut  for  stone  in  the  bladder,  employing  for  this  purpose 
the  lateral  method  of  operating;  and  they  performed  a 
great  variety  of  plastic  operations. 

Some  of  their  hygienic  rules  concerning  pregnant  and 
nursing  women  are  eminently  practical;  others  would 
hardly  be  approved  by  modern  accoucheurs.  Here  are  a 
few  of  these  rules:  During  the  period  of  a  woman's 
pregnancy  close  attention  should  be  paid  to  her  diet,  and 


ORIENTAL  MEDICINE  37 

special  care  should  be  exercised  by  her  to  avoid  excesses 
or  errors  of  any  kind.  When  the  ninth  month  is  reached 
she  should  take  up  her  abode  in  the  small  cottage  in  which 
she  is  eventually  to  be  confined — a  building  erected  with 
special  religious  ceremonies  and  thoroughly  fitted  with 
everything  that  is  likely  to  conduce  to  her  comfort.  At  the 
time  of  the  actual  confinement  she  should  have  with  her 
four  female  assistants,  and  all  those  measures,  of  either  a 
religious  or  a  practical  character,  which  have  in  view  the 
hastening  of  the  birth  of  the  infant,  should  be  scrupulously 
carried  out.  If  any  delay  in  the  delivery  of  the  after-birth 
occurs,  the  removal  of  the  mass  may  be  promoted  by  the 
employment  of  well-directed  pressure  over  the  lower  part 
of  the  abdomen,  by  shaking  the  body,  and  also,  if  necessary, 
by  giving  an  emetic.  The  woman  in  childbed  should  not  be 
allowed  to  get  up  before  the  tenth  day  after  her  confine- 
ment, and  for  a  period  of  six  weeks  her  diet  should  be  most 
carefully  watched.  On  the  third  day  the  child  should  be 
put  to  the  mother's  breast;  up  to  that  time  it  should  be 
given  only  honey  and  butter.  If  the  mother,  for  any 
reason,  is  not  able  to  suckle  the  infant,  a  wet-nurse  should 
be  employed  for  the  purpose,  but  not  until  the  physician 
shall  have  subjected  her  to  a  most  thorough  examination 
and  shall  have  instructed  her  minutely  in  regard  to  her 
own  diet.  The  subsequent  care  of  the  child  was  provided 
for  in  the  most  particular  manner :  It  was  restricted  to  a 
carefully  planned  diet;  it  was  not  allowed  to  sit  or  to  lie 
except  in  certain  prescribed  positions ;  its  times  for  sleep- 
ing were  strictly  ordered ;  it  was  permitted  to  amuse  itself 
only  in  certain  ways; — in  brief,  everything  was  done 
according  to  strict  rules,  even  special  precautions  being 
taken  to  guard  the  child,  during  the  first  years  of  life, 
against  dangerous  demons.  Weaning  began  after  the 
sixth  month,  and  for  a  certain  length  of  time  the  child  was 
fed  largely  on  rice.  In  cases  of  difficult  labor  and  in  their 
gynaecological  practice  the  physicians  of  ancient  India  did 
not  manifest  any  special  knowledge  or  skill. 

One  of  the  instructions  given  to  young  physicians  in 
India  when  they  were  about  to  enter  upon  the  practice  of 


38  GROWTH  OF  MEDICINE 

their  profession,  may  be  of  interest  to  the  reader.  It  is 
worded  as  follows:  ''Let  thy  hair  and  finger  nails  be  cut 
short,  keep  thy  body  clean,  put  on  white  garments,  wear 
shoes  on  thy  feet,  and  carry  a  staff  or  umbrella  in  thy  hand. 
Thy  demeanor  should  be  humble,  and  thy  heart  pure  and 
free  from  deceitf ulness. ' '  The  following  proverb,  although 
it  originated  in  India,  is  well  worthy  of  acceptance  in  every 
part  of  the  world:  ''When  you  are  ill  the  physician  will 
be  to  you  a  father;  when  you  have  recovered  from  your 
illness  you  will  find  him  a  friend;  and  when  your  health 
is  fully  re-established  he  will  act  as  your  protector." 

On  a  previous  page  the  statement  has  been  made  that 
the  science  and  art  of  medicine  developed  in  ancient  Greece 
quite  independently  of  any  influence  that  might  have  been 
exerted  by  the  teachings  of  the  physicians  of  India.  This 
statement  should  be  somewhat  modified,  for  it  is  reasonable 
to  suppose,  although  directly  confirmatory  evidence  has 
not  yet  been  discovered,  that,  through  the  channels  of  trade 
between  the  two  countries,  some  knowledge  of  the  doings 
of  the  physicians  of  India  must  have  reached  the  ears  of 
their  Greek  brethren.  On  the  other  hand,  at  a  later  period 
of  history  (after  Alexander  the  Great  had  invaded  India), 
the  relations  between  the  two  countries  became  quite  close 
and  were  kept  up  without  a  break  for  several  hundred 
years.  During  the  earlier  part  of  this  later  period,  as 
appears  from  the  writings  of  Hippocrates,  Dioscorides  and 
Galen,  various  drugs  and  methods  of  treatment  employed 
by  the  physicians  of  India  were  adopted  by  the  practitioners 
of  Greece. 

Medicine  of  the  Chinese  and  Japanese. — The  isolation 
of  China  with  respect  to  those  countries  which  were  within 
comparatively  easy  reach  and  in  which  there  was  a  civiliza- 
tion that,  already  several  thousand  years  before  the 
Christian  era,  had  attained  a  remarkable  degree  of 
development  (India,  Babylonia  and  Egypt,  for  example) ; 
her  blind  belief  in  authority ;  her  unwillingness  to  tolerate 
any  influences  that  seemed  to  emanate  from  foreigners; 
and  her  complete  satisfaction  with  her  own  methods  of 
doing  things,  with  her  own  beliefs,   and  with  her   own 


ORIENTAL  MEDICINE  39 

natural  and  manufactured  products, — these,  it  is  generally 
believed,  were  the  most  important  factors  in  keeping  this 
remarkable  nation  in  a  state  of  immobility  as  regards  at 
least  some  departments  of  human  knowledge  and  accom- 
plishment. This  is  particularly  true  in  respect  of  the 
science  and  art  of  medicine.  But  China  is  at  last  waking 
up  from  this  lethargic  state.  A  wonderful  change  has  come 
over  her  during  the  past  twenty  or  thirty  years,  and  she 
is  now  beginning  to  realize  that,  with  her  millions  of 
population  and  wonderful  natural  resources,  she  has  an 
important  part  to  play  in  advancing  the  civilization  of  the 
world. 

The  preceding  remarks  must  not  be  interpreted  as 
signifying  that,  during  the  long  ages  of  the  past,  China  has 
not  been  developing  and  is  not  able  at  the  present  time  to 
show  a  record  of  very  creditable  work  accomplished  in 
many  departments  of  human  activity.  In  her  early  history, 
many  centuries  ago,  she  accomplished  great  things,  and 
all — so  far  as  we  now  know — ^without  aid  from  neighboring 
nations;  but  there  came  a  time  when  all  this  creative 
activity  ceased,  and  then,  for  long  periods  of  years,  she 
appeared  to  rest  satisfied  with  the  advances  which  she  had 
already  made,  and  to  have  no  further  ambition  to  add  to 
the  stock  of  her  possessions. 

Among  the  valuable  things  which  should  be  credited  to 
the  Chinese  are  the  following:  the  discovery  of  the  compass 
(about  1100  B.  C),  the  making  of  porcelain,  the  invention 
of  printing,  the  raising  of  silkworms,  the  manufacture  of 
glass  and  of  paper,  the  successful  dyeing  with  purple, 
embroidering  with  gold,  working  in  metals,  the  artistic 
cutting  of  precious  stones,  enameling,  the  making  of  * '  India 
ink,"  etc.  Furthermore,  it  is  a  fact  most  creditable  to  the 
Chinese  that  in  no  other  country  in  the  world  have  scholars 
been  held  in  such  high  esteem,  or  assigned  so  high  a  rank, 
as  they  have  been  and  still  are  in  China. 

Chinese  medicine  possesses  a  very  rich  literature.  The 
first  medical  treatise,  which  deals  with  plants  that  possess 
medicinal  virtues,  is  ascribed  to  the  Emperor  Schin-Nung, 
who  flourished  about  2800  B.  C.    This  is  the  monarch  who 


40  GROWTH  OF  MEDICINE 

taught  his  people  from  which  springs  they  should  drink, 
and  who  tested  all  the  plants  of  his  vast  empire  with 
reference  to  their  healing  properties.  According  to  the 
legend  the  wall  of  his  stomach  was  so  thin  that  he  could 
look  through  it  and  see  everything  that  was  going  on  in  the 
interior  of  that  organ.  In  this  way  he  was  able  to  carry 
on  a  large  series  of  experiments  upon  himself  in  regard 
to  the  action  of  different  poisons  and  their  antidotes.  It 
is  also  related  that  medical  knowledge  was  still  further 
advanced  by  the  yellow  Emperor  Hoang-Ti  who  lived  about 
2650  B.  C,  and  who  is  credited  by  the  Chinese  with  having 
invented  arithmetic  and  music.  The  treatise  called  ''Noi- 
King,"  which  deals  with  the  subject  of  internal  diseases 
and  gives  a  systematic  account  of  human  anatomy,  is  also 
credited  by  the  Chinese  to  this  monarch;  but  Neuburger 
maintains  that  this  book,  which  is  still  in  common  use  in 
China,  is  of  much  more  recent  origin.  There  are  several 
other  medical  treatises  which  deserve  to  be  mentioned. 
Such,  for  example,  are  the  following:  the  celebrated  book 
on  the  pulse,  written  by  Wang-Schu-Scho  in  the  third 
century  B.  C. ;  two  very  important  books  written  by  Cho- 
Chiyu-Kei — one  bearing  the  title  ''Schang-Han-Lun"  (On 
Fevers)  and  the  other  that  of  ''Kin-Kwei"  (Golden 
Casket) ; — the  different  treatises  written  by  Tschang-Ki 
(tenth  century  A.  D.)  and  published  in  the  collection  called 
**The  Golden  Mirror  of  the  Forefathers  in  Medicine"  (I- 
Tsung-Kin-Kien") ;  and,  finally,  the  very  popular  modern 
work  (in  forty  volumes)  entitled  ^'The  Trustworthy  Guide 
in  the  Science  and  Art  of  Medicine"  ('*Ching-Che-Chun- 
Ching").  Of  these  forty  volumes,  seven  are  devoted  to 
nosology,  eight  to  pharmacy,  five  to  pathology,  six  to 
surgery,  and  the  remainder  to  children's  and  women's 
diseases. 

Anatomy,  it  appears,  has  never  played  other  than  a  very 
insignificant  part  in  the  Chinese  system  of  medicine.  This 
is  not  to  be  wondered  at  when  we  remember  that  their 
religion  makes  the  dissection  of  a  human  body  a  sin  worthy 
of  punishment.  No  mutilated  person,  the  Chinese  believed, 
would  be  permitted,  upon  reaching  the  domain  of  the  dead, 


ORIENTAL  MEDICINE  41 

to  rejoin  Ms  ancestors.  About  the  year  1700  A.  D.  the 
Emperor  Kang-Hi  made  the  attempt  to  incorporate 
anatomy  as  a  part  of  the  regular  study  of  medicine  in 
the  Chinese  Empire ;  his  first  step  being  the  authorization 
of  P.  Perennin,  a  Jesuit  Father,  to  translate  Dionis'  work 
on  anatomy  into  the  Chinese.  His  efforts  were,  however, 
unsuccessful,  owing  to  the  strong  opposition  offered  by  the 
native  physicians.  And  the  attempts  made  during  more 
recent  times  to  accomplish  the  desired  reform  by  intro- 
ducing copies  of  European  anatomical  illustrations  do  not 
appear,  as  yet,  to  have  produced  any  appreciable  impres- 
sion. In  very  recent  years,  however,  the  medical  mission- 
aries, sent  out,  if  I  am  rightly  informed,  from  the  United 
States,  are  giving  excellent  instruction  in  anatomy. 

Physiology,  as  taught  by  the  Chinese,  is  something 
beyond  the  comprehension  of  modern  Europeans.  Neu- 
burger  explains  their  views  in  the  following  manner: 
''The  cosmos  is  the  product  of  the  combined  action  of  two 
dissimilar  forces — the  male  (Yang)  and  the  female  (Yin). 
When  these  forces  work  in  harmony  a  state  of  equilibrium 

results Matter    consists    of    five    elements,    viz., 

wood,  fire,  earth,  metal,  and  water;  and  all  things  are 
composed  of  these  elements.  In  sympathetic  relationship 
with  these  five  elements  stand  the  five  planets  (Jupiter, 
Mars,  Saturn,  Venus,  Mercury),  the  five  different  kinds  of 
air  (wind,  heat,  moisture,  dryness,  cold),  the  five  quarters 
of  the  globe  (east,  south,  west,  north  and  the  equator), 
the  five  periods  of  the  year  (in  addition  to  the  four  which 
we  recognize,  the  Chinese  make  a  fifth  period  out  of  the 
last  eighteen  days  of  spring,  summer,  autumn  and  winter), 
the  five  times  of  day,  the  five  colors  (green  or  blue,  red, 

yellow,  white  and  black),  the  five  musical  tones,  etc 

As  in  the  cosmos,  so  in  man  the  two  primeval  forces — 
Yang  and  Yin — underlie  all  his  vital  processes.  Thus,  his 
body  is  made  up  of  the  five  elements  of  which  all  matter  is 
composed,  and  health  depends  upon  the  maintenance  of 
a  state  of  equilibrium  between  the  male  and  the  female 
forces,  etc."    After  this  brief  exposition  it  seems  unneces- 


42  GROWTH  OF  MEDICINE 

sary  to  devote  any  further  space  to  the  consideration  of 
the  physiological  doctrines  of  the  Chinese. 

With  respect  to  the  questions  of  diagnosis  and  prognosis 
it  may  be  stated  that  the  Chinese  attach  great  importance 
to  the  necessity  of  making  a  most  careful  objective  exami- 
nation of  the  entire  body;  but,  when  one  investigates  the 
precise  manner  in  which  this  examination  is  to  be  carried 
out,  it  soon  appears  that  most  of  the  details  relate  to 
matters  of  a  purely  fanciful  or  mystical  nature.  The  only 
steps  of  real  importance,  according  to  them,  are  the  exami- 
nation of  the  patient's  pulse  and  the  inspection  of  his 
eyesight  and  his  tongue.  From  the  examination  of  the 
pulse  alone  they  believe  it  possible  to  diagnose  the  nature 
and  seat  of  the  disease.  To  examine  the  pulse  properly  is 
a  complicated  affair  and  can  scarcely  be  carried  out  in 
actual  practice  in  less  time  than  ten  minutes;  indeed,  in 
certain  cases  the  physician  may  find  it  necessary  to  devote 
two  or  three  hours  to  the  business.  According  to  the 
Chinese  scheme  there  are  many  different  kinds  of  pulse, 
and  there  are  no  less  than  thirty-seven  different  types  of 
condition  presented  by  the  tongue,  each  bearing  its  own 
special  pathological  significance. 

Disease,  so  reads  the  Chinese  doctrine,  is  a  discord,  a 
disturbance  of  equilibrium,  caused  by  the  preponderance 
of  one  or  the  other  of  the  primeval  forces  (the  male  or  the 
female).  It  manifests  itself  in  some  disorder  of  the 
circulation  of  the  vital  air  and  the  blood,  and  eventually 
involves  the  organs  of  the  body.  Wind,  cold,  dryness, 
moisture,  the  emotions  and  passions,  poisons,  and  also  evil 
spirits  and  imaginary  beasts  are  the  causes  of  disease. 

No  other  nation,  says  Neuburger,  has  at  its  command 
such  a  large  number  of  remedial  drugs;  and  it  is  also  a 
fact,  he  adds,  that  the  department  of  therapeutics  is  that 
in  which  Chinese  medicine  has  reached  its  highest  develop- 
ment. The  steadfast  belief  that  in  nature  there  exists  a 
remedy  for  every  human  ill  led  the  physicians  of  that 
country  to  search  diligently  in  all  possible  directions  for 
vegetable  and  animal  and  also,  to  some  extent,  mineral 
substances  which  might  possess  remedial  virtues.    Although 


ORIENTAL  MEDICINE  43 

this  search  necessarily  brought  to  notice  a  lot  of  useless 
drugs,  it  cannot  be  denied  that  eventually  it  added  a 
considerable  number  of  remedies  which  have  proved  useful 
to  the  medical  profession  of  the  entire  world.  In  this 
category  belong  the  following:  rhubarb,  pomegranate  root 
as  a  cure  for  worms,  camphor,  aconite,  cannabis,  iron  (for 
the  relief  of  anaemia),  arsenic  (for  malarial  and  skin 
diseases),  sulphur  and  mercury  (both  of  these  for  affections 
of  the  skin),  sodium  sulphate,  copper  sulphate  (as  an 
emetic),  alum,  sal  ammoniac  and  musk  (for  nervous 
affections).  Toward  the  middle  of  the  sixteenth  century 
A.  D.  there  was  published,  under  the  title  ''Pen-Tsao- 
Kang-Mu,"  a  monumental  work  (fifty-two  volumes)  in 
which  are  very  fully  described  no  fewer  than  1800  remedies, 
mostly  of  a  vegetable  nature.  Prophylactic  Inoculation 
with  the  pus  from  a  smallpox  pustule  was  practised  by  the 
Chinese  as  long  ago  as  during  the  eleventh  century  A.  D., 
''thus  constituting  a  forerunner  of  our  modern  serum 
therapy."  (Neuburger.)  Vaccination  was  not  introduced 
into  China  until  during  the  nineteenth  century  of  the 
present  era.  It  is  a  curious  fact  that,  in  the  choice  of  a 
remedy,  the  Chinese  physicians  attach  a  certain  degree  of 
importance  to  the  form  and  color  of  the  drug,  as  symbols 
indicative  of  the  effect  which  they  may  be  expected  to 
produce.  Thus,  the  red  blossoms  of  the  hibiscus  plant  are 
believed  to  be  more  efiicacious  than  the  white  as  an 
emmenagogue;  saffron,  being  of  a  yellow  color,  possesses 
the  power  to  relieve  jaundice;  beans  that  have  the  shape 
of  a  kidney  should  be  prescribed  in  cases  of  renal  disease ; 
glow-worms  should  form  a  part  of  all  eye-washes,  etc. 

The  doses  prescribed  are  very  large,  and  the  medicines 
are  often  put  up  in  an  attractive  form,  with  labels  on  which 
such  descriptive  titles  as  these  are  written:  ''Powders  of 
the  Three  very  wise  Men,"  or  "Powders  recommended  by 
Five  Distinguished  Physicians" — titles  which  are  calcu- 
lated to  work  upon  the  imagination  of  the  patient. 

There  are  two  methods  of  treatment  which  the  Chinese 
physicians  are  very  fond  of  employing  for  the  relief  of  a 
great  variety  of  diseases — viz.,  acupuncture  and  cauteriza- 


44  GROWTH  OF  MEDICINE 

tion  of  the  skin  over  the  seat  of  the  malady  by  means  of 
what  are  termed  *'moxae" — moxibustion.  Moxae  are  pre- 
pared by  kneading  together  into  a  cone-shaped,  tinder-like 
mass  the  leaves  of  the  artemisia  vulgaris,  then  drying  it 
thoroughly.  Such  a  mass  is  attached  to  the  skin  at  the 
affected  spot  by  simply  moistening  the  base  of  the  cone, 
after  which  the  apex  is  ignited.  Some  physicians  prefer 
to  interpose  a  thin  sheet  of  metal  between  the  skin  and  the 
base  of  the  moxa.  The  manner  in  which  these  contrivances 
should  be  used  in  the  different  diseases  and  the  proper 
number  to  employ  are  matters  subject  to  fixed  rules.  In 
a  strong  individual,  for  example,  as  many  as  fifty  moxae 
may  be  used  at  a  time.  In  affections  of  the  chest  they  were 
applied  to  the  patient's  back,  in  diseases  of  the  stomach 
to  the  shoulders,  and  in  venereal  affections  over  the  spinal 
column.  In  acupuncture,  which  is  a  procedure  invented 
by  the  Chinese,  slender  needles  of  gold,  silver  or  highly 
tempered  steel,  from  5  to  22  centimetres  (2  in.-8%  in.)  in 
length,  were  forced  through  the  stretched  skin  to  different 
depths  (1%  in.-134  in.)  and  then  driven  farther  inward  in 
a  rotary  direction  by  means  of  a  small  hammer.  The 
needles,  after  being  allowed  to  remain  in  situ  for  a  few 
minutes,  were  withdrawn,  and  pressure  was  made  with 
the  hand  over  the  small  wounds,  or  a  moxa  was  burned 
over  the  spot.  There  are  in  all  388  places  where  acu- 
puncture may  be  performed,  and  a  chart  of  the  body, 
showing  where  these  places  are  located,  has  been  prepared 
for  the  guidance  of  the  Chinese  physicians.  Neuburger 
calls  attention  to  the  fact  that  the  latter  dislike  the  sight 
of  blood,  and  that  this  is  one  of  the  reasons  why  acupunc- 
ture and  the  use  of  moxae  have  grown  to  be  such  popular 
remedies.  Bloodletting  is  rarely  employed  by  them;  but 
dry  cupping,  on  the  contrary,  is  a  favorite  procedure  in 
certain  maladies.  Massage  is  generally  performed  by  old 
or  blind  women,  and  much  attention  is  devoted  to  the 
''movement  cure,"  which  is  said  to  have  been  invented 
about  2500  B.  C. 

As   may  readily  be  imagined,   the   Chinese — owing  to 
their  dislike  for  the  sight  of  blood  and  also  by  reason  of 


ORIENTAL  MEDICINE  45 

their  ignorance  of  anatomy — ^have  not  advanced,  in  sur- 
gery, beyond  the  most  primitive  state  of  that  art. 

The  science  of  public  health  is  quite  unknown  in  China. 
In  a  Chinese  treatise  entitled  ''Long  Life,"  the  following 
advice  is  given:  ''Always  rise  early  in  the  morning,  take 
some  breakfast  before  you  leave  your  residence,  drink  a 
little  tea  before  eating,  at  the  mid-day  meal  partake  of 
well-cooked  but  not  too  highly  salted  food,  eat  slowly,  take 
a  nap  of  two  hours  after  the  meal,  eat  lightly  at  night,  and, 
before  going  to  bed,  rinse  your  mouth  with  tea  and 
have  the  soles  of  your  feet  rubbed  until  they  are  warm." 
(Neuburger.) 

Up  to  the  latter  part  of  the  nineteenth  century  of  the 
present  era,  Japan,  so  far  as  medical  matters  are  con- 
cerned, differed  in  no  material  respect  from  China.  During 
the  last  fifty  or  sixty  years,  however, — that  is,  since  the 
visit  of  Commodore  Perry,  of  the  United  States  Navy,  to 
that  country, — wonderful  changes  have  taken  place;  and 
now  Japan,  as  a  result  of  her  determination  to  adopt  the 
methods  of  education,  of  utilizing  steam  and  electric  power, 
etc.,  has  already  taken  a  leading  place  in  the  council  of 
nations.  The  physicians,  many  of  whom  received  their 
training  in  the  best  schools  of  Europe  and  the  United 
States,  are  contributing  to-day  their  full  share  toward 
advancing  the  science  of  medicine.  That  China  is  fol- 
lowing in  the  footsteps  of  Japan  is  already  plainly  evident, 
and  no  intelligent  observer  entertains  the  slightest  doubt 
of  her  ultimately — probably  at  no  distant  day — possessing 
a  corps  of  medical  men  as  well  educated,  as  efficient  in  the 
treatment  of  disease,  and  as  practical  in  public  hygiene  as 
their  European  and  American  confreres.  During  thou- 
sands of  years  China  has  suffered  severely  from  the 
blighting  tyranny  of  superstition,  priestcraft  and  selfish 
bureaucracy,  and,  now  that  the  sunlight  of  truth  and 
genuine  liberty  is  beginning  to  search  every  nook  and 
cranny  of  that  great  country,  we  who  have  had  the  advan- 
tage of  this  beneficent  influence  for  so  many  scores  of  years 
truly  rejoice  over  the  change  that  is  taking  place  in  China. 


CHAPTER  IV 

GREEK  MEDICINE  AT  THE  DAWN  OF  HISTORY 

It  is  from  Greece  and  from  Greece  alone,  says  Darem- 
berg,  that  our  modern  medicine  derives  its  origin. 

It  has  come  down  to  us,  in  a  direct  line,  through  the  sheer  force 
of  its  inherent  excellence,  and  with  little  or  no  aid  from  outside 
sources.  Harvey,  Bichat  and  Broussais  are  as  much  the  legitimate 
heirs  of  Hippocrates,  Herophilus,  Galen,  Berenger  de  Carpi  and 
Vesalius,  as  Hippocrates  is  the  heir  of  Homer,  and  as  this  divine 
singer  of  the  anger  of  Achilles  is  himself  the  product  of  a  civiliza- 
tion that  existed  before  his  day  and  that  was  in  all  probability  the 
creation  of  Hindu  influences. 

It  is  to  the  development  of  medical  knowledge  in  Greece, 
therefore,  that  our  attention  should  next  be  directed,  and 
more  particularly  to  that  period  which  belongs  to  the  dawn 
of  history — the  pre-Homeric  period. 

The  pre-Homeric  Period  of  Medicine  in  Greece. — The 
poems  of  Homer,  the  Iliad  and  the  Odyssey,  furnish  us 
with  the  earliest  and  almost  the  only  written  evidence  of 
the  state  of  medicine  in  Greece  during  that  period  of  time. 
They  were  probably  written,  according  to  the  authority 
of  the  Earl  of  Derby,  somewhere  about  800  B.  C,  and 
modern  investigations  show  that  the  siege  of  Troy,  the 
theme  of  the  Iliad,  occurred  between  the  years  1194  and 
1184  B.  C.  These  investigations  also  show  that  in  this 
region,  and  especially  in  the  Island  of  Crete  and  in  Mycenae 
on  the  neighboring  mainland  of  Asia  Minor,  at  this  time 
and  probably  several  hundred  years  earlier,  there  existed 
a  high  degree  of  civilization.  Specimens  of  a  written 
language,  for  example,  were  found  among  the  objects 
recovered  from  the  ruins  of  the  palace  of  King  Minos  at 


GREEK  MEDICINE  47 

Cnossus  in  Crete,  but  hitherto  no  interpreter  of  this 
unknown  language  has  been  found.  It  is  reasonable  to 
expect,  however,  that  in  due  time  these  Minoan  records 
will  be  translated,  that  still  other  records  belonging  to  this 
remote  age  will  be  discovered,  and  that  much  valuable 
information  regarding  the  condition  of  medical  knowledge 
in  Greece  during  this  long  period  will  then  be  revealed  to 
us.  Strange  as  it  may  appear,  the  classical  Greek  writers 
seem  to  have  possessed  very  little  knowledge  concerning 
this  highly  developed  civilization  at  Cnossus.  And  yet,  if 
we  stop  to  consider  the  matter,  their  silence  will  appear 
less  strange  for  the  following  reasons.  Some  great 
calamity  (war,  an  earthquake,  or  a  conflagration)  must 
have  destroyed  many  of  the  evidences  of  Minoan  civiliza- 
tion besides  those  which  are  now  being  brought  to  light; 
then,  also,  several  hundred  years  elapsed  between  the 
occurrence  of  this  disaster  and  the  classical  period  of 
Greek  culture ;  and,  finally,  there  is  the  fact  that  the  knowl- 
edge of  past  historical  events,  when  kept  alive  simply  by 
tradition,  slowly  vanishes,  until  finally  it  becomes  so  vague 
as  to  possess  very  little  value.  The  discoveries  made  in 
the  Island  of  Crete  and  at  Mycenae  were  not  known  to 
Daremberg  when  he  wrote  the  lines  quoted  above,  but  he 
felt  perfectly  sure,  from  his  knowledge  of  the  laws  of 
development  in  general,  that  a  product  so  highly  cultured 
as  Homer  could  not  have  suddenly  sprung  into  existence 
out  of  the  apparent  darkness  and  ignorance  of  the  centuries 
immediately  preceding  his  time. 

The  State  of  Medical  Knowledge  at  the  Time  of  the  Siege 
of  Troy. — It  is  from  Homer's  Iliad  and  Odyssey  that  our 
authoritative  knowledge  of  the  most  ancient  Greek  medicine 
is  derived.  In  the  former  work  mention  is  made  of 
Aesculapius  and  his  two  sons,  Machaon  and  Podalirius, 
both  of  whom  accompanied  Agamemnon  and  the  Greek 
host  in  their  expedition  against  Troy.  According  to  this 
author's  account  they  served  in  the  double  capacity  of 
surgeons  to  the  army  and  valiant  leaders  of  troops.  In 
order  that  the  reader  may  judge  for  himself  just  what  is 
the  nature  of  the  evidence  furnished  by  Homer  with  regard 


48  GROWTH  OF  MEDICINE 

to  the  medical  knowledge  of  that  period,  it  seems  desirable 
to  introduce  here  a  few  of  the  more  characteristic  refer- 
ences which  the  poet  makes  to  spear,  javelin  and  arrow 
wounds,  to  the  injuries  caused  by  fragments  of  rocks 
hurled  by  the  assailants,  and  to  various  remedial  measures, 
both  surgical  and  medical,  employed  for  the  relief  of  the 
wounded  or  sick  warriors.  There  are  at  least  one  hundred 
such  passages  in  the  Iliad  alone,  but  the  few  which  are  here 
cited  will  serve  as  adequate  examples  of  Homer's  famil- 
iarity with  anatomy  and  with  some  of  the  methods  of 
treating  spear  and  arrow  wounds, — a  familiarity  which 
indicates  that  the  poet  must  have  had  some  medical  training. 

Thus  he ;  and  not  unmoved  Machaon  heard : 

They  through  the  crowd,  and  through  the  wide-spread  host, 

Together  took  their  way ;  but  when  they  came 

Where  fair-hair 'd  Menelaiis,  wounded,  stood, 

Around  him  in  a  ring  the  best  of  Greece, 

And  in  the  midst  the  godlike  chief  himself, 

From  the  close-fitting  belt  the  shaft  he  drew, 

With  sharp  return  of  pain ;  the  sparkling  belt 

He  loosen 'd,  and  the  doublet  underneath, 

And  coat  of  mail,  the  work  of  Arm  'rer  's  hand. 

But  when  the  wound  appeared  in  sight,  where  struck 

The  stinging  arrow,  from  the  clotted  blood 

He  cleans 'd  it,  and  applied  with  skilful  hand 

The  healing  ointments,  which,  in  friendly  guise. 

The  learned  Chiron  to  his  father  gave. 

(Book  lY.  of  the  Iliad,  Lines  221-259.) 


He  said :  the  spear,  by  Pallas  guided,  struck 

Beside  the  nostril,  underneath  the  eye ; 

Crashed  through  the  teeth,  and  cutting  through  the  tongue 

Beneath  the  angle  of  the  jaw  came  forth : 

Down  from  the  car  he  fell ;  and  loudly  rang 

His  glittering  arms :  aside  the  startled  steeds 

Sprang  devious :  from  his  limbs  the  spirit  fled. 

Down  leaped  Aeneas,  spear  and  shield  in  hand. 

Against  the  Greeks  to  guard  the  valiant  dead; 

And  like  a  lion,  fearless  in  his  strength, 


GREEK  MEDICINE  49 

Around  the  corpse  he  stalk 'd,  this  way  and  that, 

His  spear  and  buckler  round  before  him  held, 

To  all  who  dar  'd  approach  him  threatening  death, 

"With  fearful  shouts ;  a  rocky  fragment  then 

Tydides  lifted  up,  a  mighty  mass, 

"Which  scarce  two  men  could  raise,  as  men  are  now : 

But  he,  unaided,  lifted  it  with  ease. 

With  this  he  smote  Aeneas  near  the  groin, 

"Where  the  thigh  bone,  inserted  in  the  hip. 

Turns  in  the  socket  joint ;  the  rugged  mass 

The  socket  crushed,  and  both  the  tendons  broke. 

And  tore  away  the  flesh :  down  on  his  knees, 

Yet  resting  on  his  hand,  the  hero  fell ; 

And  o'er  his  eyes  the  shades  of  darkness  spread. 

(The  Iliad,  Book  V.,  Lines  333-356.) 


He  said,  and  passing  his  supporting  hand 

Beneath  his  [Eurypylus']  breast,  the  wounded  warrior  led 

"Within  the  tent ;  th '  attendant  saw,  and  spread 

The  ox-hide  couch ;  then  as  he  lay  reclined, 

Patroclus,  with  his  dagger,  from  the  thigh 

Cut  out  the  biting  shaft ;  and  from  the  wound 

"With  tepid  water  cleans  'd  the  clotted  blood ; 

Then,  pounded  in  his  hands,  a  root  applied 

Astringent,  anodyne,  which  all  his  pain 

Allayed;  the  wound  was  dried,  and  stanch 'd  the  blood. 

(The  Iliad,  Book  XI.,  Lines  958-967.) 
•        #****«#« 

But  Jove-born  Helen  otherwise,  meantime. 

Employed,  into  the  wine  of  which  they  drank 

A  drug  infused,  antidote  to  the  pains 

Of  grief  and  anger,  a  most  potent  charm 

For  ills  of  every  name.^    "Whoe  'er  his  wine 

So  medicated  drinks,  he  shall  not  pour 

All  day  the  tears  down  his  wan  cheeks,  although 

His  father  and  his  mother  both  were  dead, 

Nor  even  though  his  brother  or  his  son 

Had  fallen  in  battle,  and  before  his  eyes. 

(Book  IV.  of  the  Odyssey,  Lines  275-284.) 
1  Nepenthes,  believed  to  be  opium,  is  the  word  employed  in  the  original. 


50  GROWTH  OF  MEDICINE 

In  former  years  and  down  almost  to  the  present  time, 
it  was  the  custom  among  English  medical  writers  to  speak 
of  Aesculapius  only  as  the  ''God  of  Medicine,"  thus  con- 
veying to  the  minds  of  many  readers  that  he  was  a 
mythological  character,  not  a  real  personage.  To-day,  and 
especially  since  Schliemann  has  demonstrated,  by  his 
excavations  at  the  site  of  ancient  Troy,  that  Homer's 
Iliad  is  not  merely  a  beautiful  creation  of  his  poetic  fancy, 
but  a  narration  of  events  that  actually  occurred  about  1200 
B.  C,  it  is  quite  generally  acknowledged  that  Aesculapius^ 
is  an  historical  character,  an  individual  whose  memory 
should  receive  due  honor  from  the  physicians  of  modern 
times.  Neither  Homer  nor  Pindar  speaks  of  him  as  a  god. 
In  Athens  he  was  publicly  deified  in  420  B.  C. 

When  Daremberg,  as  quoted  above,  expressed  the  belief 
that  Hippocrates  was  the  product  of  an  earlier  civilization, 
he  undoubtedly  gave  due  weight  to  other  circumstances 
beside  those  which  are  narrated  in  Homer's  poems — 
circumstances,  for  example,  which  are  referred  to  casually 
by  several  of  the  classical  Greek  authors,  and  to  which 
fresh  importance  has  been  given  by  a  number  of  recent 
discoveries.  Thus,  there  is  an  abundance  of  evidence 
showing  that  the  Greeks,  both  before  and  after  Homer's 
time,  held  the  memory  of  Aesculapius  in  the  very  highest 
honor.  So  great,  as  they  believed,  was  his  power  over 
disease,  so  wonderful  were  the  cures  which  he  accomplished, 
and  so  noble  and  pure  was  his  character,  that  they  made 
him  a  god  and  erected  temples  in  his  honor — not  mere 
places  where  a  barren  worship  might  be  carried  on,  but 
veritable  sanatoria — termed  Asclepieia — where  the  extraor- 
dinary healing  powers  of  him  whom  they  had  made  a 
god  might  be  perpetuated  for  the  benefit  of  succeeding 

2  Aesculapius  was  held  to  be  the  son  of  Apollo,  the  god  of  medicine,  and  to 
have  been  instructed  in  the  art  of  healing  by  Chiron,  one  of  the  centaurs. 
Beside  his  famous  sons,  Machaon  and  Podalirius,  he  had  four  daughters  whose 
names — Hjgieia,  Jaso,  Panakeia  and  Aigle — have  come  down  to  us  through 
the  ages.  His  wife's  name  was  Epione,  and  those  of  his  two  younger  sons 
were  Telesphorus  and  Janiscus,  but  all  three  of  these  names  are  rarely  men- 
tioned by  the  Greek  writers. 


GREEK  MEDICINE  51 

generations.  While,  on  the  one  hand,  the  ancient  Greeks 
may  have  been  full  of  superstitious  beliefs,  they  were  at 
the  same  time  as  kindly  disposed  toward  their  fellow  men, 
as  generous  in  their  spending  of  money  for  this  purpose, 
and  as  practical  in  their  selection  of  suitable  methods  as 
are  the  benefactors  of  to-day  all  over  the  world.  In  course 
of  time  these  so-called  temples  became  the  prototypes  of 
our  hospitals,  sanatoria  and  schools  of  medicine,  and  it 
therefore  seems  only  proper  that  they  should  here  be 
described  somewhat  in  detail. 

The  so-called  Aesculapian  Temples  and  their  Chief 
Purpose. — The  first  of  these  temples,  or  Asclepieia,  were 
established  at  Trikka,  in  Thessaly ;  at  Cnidus,  on  the  coast 
of  Caria  in  Asia  Minor,  opposite  Cos;  at  Epidaurus,  in 
Argolis,  Greece ;  at  Gyrene  on  the  northern  coast  of  Lybia, 
Africa,  opposite  the  Island  of  Crete;  at  Crotona,  on  the 
southeastern  coast  of  Italy;  and,  finally,  at  Athens.  It  is 
said  that  traces  of  as  many  as  eighty  of  these  Asclepieia 
have  been  found  in  different  parts  of  the  ancient  world. 
One  of  them,  for  example,  is  known  to  have  existed  on  the 
small  island  (Isola  San  Bartolommeo)  in  the  Tiber,  at 
Rome.  Their  management  was  intrusted,  in  the  earlier 
years  of  their  existence,  to  men  who  were  descendants  of 
Aesculapius — i.e.,  the  sons  and  grandsons  of  Machaon  and 
Podalirius.  They  were  both  priests  and  physicians,  and 
are  mentioned  in  history  as  the  Asclepiadae.  With  the 
progress  of  time  it  became  necessary,  as  one  may  readily 
understand,  to  intrust  the  temple  service  to  individuals 
who  were  not  members  of  the  family  of  Aesculapius.  The 
original  Asclepiadae  guarded  as  valuable  secrets  the 
methods  of  treatment  and  the  pharmaceutic  formulae 
which  had  been  handed  down  to  them  by  the  head  of  the 
family.  It  was  therefore  natural,  when  these  newly 
adopted  members  were  installed  in  office,  that  they  should 
be  made  to  promise,  under  oath,  not  to  *' divulge  these 
secrets  to  any  but  their  own  sons,  the  sons  of  their 
teachers,  or  the  pupils  who  were  preparing  themselves  to 
become  regular  physicians."     (Neuburger.) 

The   divulging   of  these   secrets,   it   may  be    assumed, 


52  GROWTH  OF  MEDICINE 

would  gradually  entail  upon  the  organization  of  priest- 
physicians  a  serious  money  loss.  As  will  be  seen  further 
on,  the  oath  known  as  *'the  Hippocratic  Oath"  omits  these 
mercenary  features,  and  thus  places  the  vocation  of 
physician  upon  a  much  higher  level. 

It  is  an  interesting  fact,  as  noted  by  Hollaender,  of 
Berlin,  that  Homer  does  not  make  the  slightest  mention 
of  temples  dedicated  to  Aesculapius;  from  which  circum- 
stance it  may  be  inferred  that  a  long  time — perhaps  several 
hundred  years — elapsed,  after  his  death,  before  his  country- 
men realized  fully  his  greatness  and  the  value  of  the 
services  which  he  had  rendered  in  his  role  of  physician. 
Of  the  temples  which  were  then  built  in  his  honor,  all  have 
long  since  fallen  into  ruins,  but  in  recent  years  excavations 
have  been  made  at  some  of  the  more  important  of  these 
sites  and  under  the  guidance  of  competent  scholars,  and 
as  a  result  our  knowledge  of  the  state  of  medicine  in 
Greece  between  the  time  of  Homer  and  the  appearance  of 
the  Hippocratic  writings  has  been  greatly  enlarged.  The 
facts  revealed  by  these  excavations  and  the  staternents 
which  are  to  be  found  in  classical  Greek  literature,  but 
which  previously  did  not  receive  all  the  consideration  that 
they  deserved,  have  now  been  pieced  together  and  we  have 
thus  been  furnished  with  a  fairly  satisfactory  picture  of 
the  relations  of  the  different  chambers  and  spaces  in  these 
temples,  and  with  a  more  or  less  complete  account  of  the 
manner  in  which  affairs  were  conducted  by  those  in  charge. 
The  following  short  description  which  is  based  on  the 
account  recently  published  by  Professor  Meyer-Steineg  of 
Jena,  Germany,  will  put  the  reader  in  possession  of  all  the 
more  important  facts.* 

There  were  two  principal  types  of  Asclepieia — one,  like 
that  of  Epidaurus,  in  Argolis,  which  occupied  an  inland 
situation,  that  had  clearly  been  chosen  from  religious 
motives  alone,  viz.,  because  it  was  believed,  in  accordance 
with  an  ancient  tradition,  that  at  this  spot  Aesculapius  had 

3  ' '  Kranken-Anstalten  im  grieehisch-romischen  Altertum, ' '  von  Dr.  med.  et 
jur.  Theodor  Meyer-Steineg,  a.  o.  Professor  an  der  Universitat  Jena;  Verlag 
von  G.  Fischer,  1912. 


FIG.  1. 


VIEW  OF  THE  TEMPLE  OF  AESCULAPIUS 
ON  THE  ISLAND  OF  COS. 


As  it  must  have  appeared  to  the  traveler,  in  the  third  century  B.  C, 
on  his  approach  by  sea  to  the  port  of  that  island. 

Reconstitution  based  upon  recent  photographs  and  upon  surveys  by 
Herzog  {Koische  Forschungen,  1904). 

(Courtesy  of^Prof.  Dr.  Meyer-Steineg,  of  Jena,  Gennany.) 


GREEK  MEDICINE  53 

been  born — and  a  second,  like  that  of  Cos,  on  the  island  of 
the  same  name  in  the  Aegean  Sea,  which  situation  without 
doubt  had  been  chosen  chiefly  because  the  locality  was 
exceptionally  healthful.  Of  the  first  of  these  two  types 
of  temples,  the  sites  of  both  of  which  have  been  most 
carefully  studied,  very  little  need  be  said  in  this  brief 
sketch.  The  purely  medical  aspects  of  this  Asclepieion, 
to  which  at  the  height  of  its  celebrity  crowds  flocked  from 
all  parts  of  Greece,  are  of  minor  interest.  The  temple  and 
its  accessory  buildings,  which  appear  to  have  been  very 
extensive,  were  located  in  a  narrow  valley,  not  far  distant 
from  the  seaside  village  which  still  to-day  bears  the  name 
of  Epidaurus.  Then,  also,  the  locality  is  deficient  in  one 
important  respect — it  has  an  insufficient  supply  of  good 
drinking  water;  and,  finally,  it  is  only  slightly  elevated 
above  the  sea-level.  Dr.  Meyer-Steineg  remarks  that  the 
patients  who  visited  this  temple  must  have  owed  whatever 
benefit  they  derived  from  the  visit  to  other  influences  than 
those  of  a  purely  medical  or  hygienic  character.  Doubtless 
suggestion  played  an  important  part  in  any  relief  which 
they  may  have  obtained,  and  the  so-called  temple-sleep  was 
also  doubtless  a  very  effective  factor  in  this  direction. 
The  Asclepieion  at  Cos,  on  the  other  hand,  occupied  a  most 
healthful  position  on  the  northern  slope  of  the  ridge  of 
mountains  which  extends  throughout  the  entire  length  of 
the  island  and  attains  a  maximum  height  of  about  3000 
feet.    (See  Fig.  1.) 

It  now  remains  for  me  to  describe,  as  best  I  may  within 
the  limited  space  which  is  at  my  command,  the  results  of 
the  excavations  and  surveys  that  have  been  made  in  recent 
years  on  the  Island  of  Cos.  Professor  Meyer-Steineg 's 
article  on  this  subject*  is  the  source  from  which  I  have 
derived  the  information  contained  in  the  following  account. 

The  temple  and  its  associated  buildings  stood  at  an 
elevation  of  three  hundred  feet  above  the  sea-level  and  at 
a  distance  of  a  little  more  than  two  miles  from  the  city 
of  Cos.     The  heights  behind  the  temple  were  in  former 

* ' '  Kranken-Anstalten  im  griechisch-romischen  Altertum,  * '  in  Jenaer 
medisin.-historische  Beitrdge,  Jena,  1912. 


54  GROWTH  OF  MEDICINE 

times  covered  with  forests  and  afforded  ample  protection 
against  the  debilitating  and  much-dreaded  south  wind. 
A  brook  of  considerable  size  and  of  very  pure  water  passed 
through  the  temple  grounds;  the  spring  (Burinna)  from 
which  it  took  its  origin  being  located  about  300  feet  higher 
up  on  the  side  of  the  mountain.  Not  far  off,  in  the  same 
neighborhood,  is  a  mineral  spring,  the  water  from  which 
contains  both  iron  and  sulphur.  All  the  physical  conditions 
of  this  site  were,  therefore,  very  favorable  to  the  restora- 
tion of  both  mental  and  bodily  health.  Professor  Meyer- 
Steineg  declares  that  it  is  scarcely  possible  to  determine 
accurately  the  age  of  the  Cos  Asclepieion, — i.e.,  of  the 
structures  which  the  present  ruins  represent, — but  he 
believes  that  some  of  them  date  no  farther  back  than  the 
third  century  B.  C,  at  which  time  extensive  structural 
alterations  were  made.®  Then,  at  a  still  later  date  (first 
century  A.  D.),  in  consequence  of  the  damage  done  by  an 
earthquake,  C.  Stertinius  Xenophon  (at  the  instigation  of 
the  Roman  Emperor  Claudius,  whose  private  physician 
he  was)  carried  out  some  very  radical  changes.  Not  only 
were  the  separate  buildings  well  supplied  with  running 
water,  but  even  many  of  the  individual  rooms  (of  which 
there  were  a  large  number)  were  equipped  mth  the  same 
conveniences.  Hydropathy  evidently  formed  an  important 
part  of  the  treatment  in  the  reconstructed  temple.  (See 
Fig.  2.) 

As  has  been  shown  above,  the  climate,  the  freedom  from 
disturbing  factors  of  all  kinds,  the  existence  at  that  spot 
of  a  plentiful  supply  of  pure  water,  the  character  of  the 
structures  composing  the  temple  group,  and  the  wide- 
spread belief  among  the  people  that  the  Asclepiadae  were 
able,  with  the  assistance  of  the  god  Aesculapius,  to  effect 
cures  which  were  obtainable  nowhere  else — all  contributed 
to  make  the  temple  at  Cos  one  of  the  greatest  sanatoria  of 
ancient  times. 

The  buildings  which  constituted  what  is  commonly 
termed  the  ''Temple  of  Aesculapius"  at  Cos  were  located 
on   three    artificially   prepared   terraces.      The    principal 

6  All  important  traces  of  the  earlier  structures  seem  to  have  disappeared. 


rv 


FIG.  2.     BIRD'S-EYE  VIEW   OF  THE   TEMPLE   OF  AESCU- 
LAPIUS AND  ASSOCIATED  BUILDINGS  ON  THE 
ISLAND  OF  COS. 

As  they  appeared  in  the  third  century  B.  C. 

(Copied  by  permission  from  a  model  made  by  Prof.  Dr.  Meyer- 
Steineg  for  the  Medico-historical  Museum  of  the  University  of  Jena, 
Germany.) 


GREEK  MEDICINE 


55 


entrance  to  the  group,  as  the  excavations  conducted  quite 
recently  by  Herzog  show,  was  on  the  lower  terrace,  and 
faced  north — that  is,  toward  the  sea.  From  this  lower 
level  a  broad  staircase  led  to  the  second  or  intermediate 
terrace,  which,  in  turn,  was  connected  with  the  upper  one 
by  means  of  a  very  broad  and  massive  series  of  steps.  The 
southern  limit  of  this  upper  terrace  ended  abruptly  at  the 
slope  of  the  mountain.    The  arrangement  of  the  buildings 


M 

jllllii'ii' ^ 


^,m,«iiiiim«\imwt«i«iii«» 


Ha fs  St  at) 


W       i       8      B      38      •«     ia     ic      ^  '   ti      1i      toon 


PIG.  3.    GROUND  PLAN  OP  THE  ASCLEPIEION  ON  THE  ISLAND  OP  COS. 
As  Ascertained  by  the  Researches  of  Dr.  Herzogr. 

The  different  structures  are  arrangred  as  nearly  as  possible  in  the  same  positions  which 
they  occupied  in  the  third  century,  B.  C. 

A,  main  entrance  to  Asclepieion;  B,  B,  B,  gallery,  6  metres  broad,  with  colonnade  on  one 
side;  C.  open  space  or  court,  on  the  southern  side  of  which  is  a  structure  composed  of 
recesses  provided  each  with  a  bathing  basin  (/?)/  H,  staircase  leading  to  intermediate  terrace; 
a,  massive  series  of  steps  leading  to  the  upper  terrace;  *,  b,  b,  broad  gallery  similar  to  that 
shown  on  the  lower  terrace;  rf,  the  temple  proper. 

(From  Prof.  Dr.  Meyer-Steineg's  Medizinisch-historiiche  Beitrage.) 


56  GROWTH  OF  MEDICINE 

on  the  three  different  terraces  may,  in  harmony  with  the 
account  given  by  Professor  Meyer-Steineg,  be  briefly 
described  as  follows:  That  which  stood  on  the  lower 
terrace  occupied  three  sides  of  a  parallelogram  (Fig.  3), 
the  open  part  of  which  faced  south.  The  longer  side  of 
the  building  measured  about  120  metres  (390  feet)  in 
length,  and  the  two  shorter  sides  each  55  metres  (180  feet). 
The  supply  of  running  water  in  every  part  of  this  great 
building,  which  appears  to  have  been  devoted  mainly,  if 
not  entirely,  to  therapeutic  purposes,  must  have  been  most 
abundant.  The  source  from  which  the  water  came  was  the 
Burinna  spring,  situated  higher  up  on  the  mountain  at  a 
spot  far  beyond  all  possibility  of  contamination.  It  is  not 
yet  clear,  says  Dr.  Meyer-Steineg,  whether  or  not  there 
were  any  buildings  devoted  to  therapeutic  purposes  on  the 
intermediate  terrace.  (Figs.  2  and  3.)  On  the  other  hand, 
the  great  halls,  contained  in  the  large  building  which 
surrounded  the  temple  on  the  upper  terrace,  appear  to 
correspond  very  closely  to  the  rooms  that  constituted  the 
main  portion  of  the  building  on  the  lower  terrace,  and  it 
is  therefore  probable  that  this  upper  building  also  served 
some  useful  purpose  in  the  general  scheme  of  the  Ascle- 
pieion.  It  is  Herzog's  opinion — according  to  Meyer- 
Steineg — that  the  central  idea  around  which  everything 
in  this  assemblage  of  fine  buildings  revolved,  was  a  clinic 
conducted  by  the  Asclepiadae.  The  means  chiefly  employed 
at  first  for  the  restoration  of  health  were  such  simple 
agents  as  sunlight,  pure  air,  pure  drinking  water,  dietetic 
measures,  massage,  physical  exercise,  etc.,  and  yet,  when 
the  patient's  condition  seemed  to  require  their  use,  there 
was  no  hesitation  in  resorting  to  the  rational  employment 
of  drugs,  and  even  surgical  operations  were  performed. 
The  numerous  instruments  which  Dr.  Meyer-Steineg  col- 
lected at  the  site  of  the  ruins  when  he  visited  Cos  in  1910, 
furnish  ample  corroborative  evidence  of  the  correctness 
of  this  last  statement. 

Not  the  least  important  part  which  this  famous  Ascle- 
pieion  played  in  the  history  of  medicine  was  the  splendid 
opportunity  which  it  afforded  to  those  who  were  preparing 


GREEK  MEDICINE  57 

themselves  to  engage  in  the  practice  of  the  healing  art,  for 
acquiring  the  necessary  familiarity  with  the  different 
diseases  and  for  learning  how  they  should  be  treated. 

The  manner  of  conducting  the  preliminary  treatment  was 
probably  not  the  same  in  every  particular  in  all  the  different 
Asclepieia,  and  yet  in  the  main  the  plan  of  procedure 
followed  in  Epidaurus,  in  Cos  and  in  Athens  undoubtedly 
resembled  closely  that  which  Pagel  furnishes  in  his 
Geschichte  der  Medizin.  It  may  be  briefly  described  as 
follows : — 

In  the  first  place,  moribund  persons,  the  unclean,  and 
women  about  to  be  confined  were  not  admitted  into  the 
temple  enclosure.  The  management  of  the  latter  class  of 
patients  was  left  entirely  to  women  nurses,  and,  when  it 
became  evident  that  a  person  was  likely  to  die,  the  indi- 
vidual was  thereafter  cared  for  outside  the  enclosure.®  In 
short,  everything  possible  was  done  to  keep  out  of  sight 
all  such  objects  as  might  produce  an  unpleasant  impression 
upon  applicants  for  treatment.  After  preliminary  bathing 
and  dieting,  the  patient  was  conducted  into  the  temple 
enclosure  and  encouraged  to  make  offerings  and  to  pray 
to  the  god  Aesculapius,  an  imposing  statue  of  whom  in 
marble  was  one  of  the  first  things  that  confronted  him. 
As  he  was  led  about  by  the  priest  or  an  attendant,  his 
imagination  was  wrought  upon  by  the  sight  of  numerous 
votive  offerings  exposed  to  view  on  the  walls  or  columns 
of  the  buildings,  by  the  singing  of  hymns  in  adoration  of 
the  god,  and  by  the  reading  of  the  records  of  earlier  cases 
inscribed  on  tablets  or  on  the  columns.  After  his  mind  had 
thus  been  worked  upon,  he  was  asked  to  furnish  to  the 
priest  a  detailed  history  of  his  own  case  and  to  submit  to 
some  sort  of  physical  examination.  As  a  final  and  most 
important  step  in  this  first  stage  of  the  treatment  he  was 
subjected  to  what  was  termed  ''the  temple-sleep,"  during 
which  the  suggestion  of  the  proper  remedies  to  be  employed 
was  supposed  to  be  communicated  to  him  by  the  god  himself. 

« The  Emperor  Antoninus  Pius,  in  order  to  provide  properly  for  these 
patients,  erected  at  Epidaurus  a  special  building  in  which  confinement  cases 
and  those  likely  to  end  fatally  might  be  lodged. 


58  GROWTH  OF  MEDICINE 

In  our  day  it  is  difficult  to  understand  how  persons  of 
a  fair  degree  of  intelligence  could  for  so  long  a  period  have 
continued  to  believe  in  the  efficacious  interference  of  the 
deified  Aesculapius  in  their  behalf.  But  that  this  belief 
really  did  exist  is  well  known,  and  it  was  only  after  the 
lapse  of  many  centuries  that  the  faith  of  the  public  began 
to  weaken,  doubtless  through  the  influence  of  several 
factors.  Perhaps  the  most  important  of  these  was  the 
discovery  of  an  increasing  number  of  instances  of  hum- 
buggery  or  trickery,  of  which  the  officiating  priests,  in  some 
of  the  temples,  had  been  guilty.  The  satirical  writer, 
Aristophanes,  who  flourished  in  Athens  about  400  B.  C, 
describes  an  incident  of  this  nature  in  his  play  entitled 
*'Ploutos."  The  following  extracts  furnish  an  account  of 
the  doings  observed  by  the  slave  Karion  on  the  occasion 
of  his  passing  a  night  in  the  temple  enclosure  at  Athens : — 

The  Scene  throughout  is  laid  at  Athens,  in  front  of  the 
house  of  Chremulos. 


Blepsidemos :     Ought  n't  we  then  to  bring  in  some  doctor? 

Chremulos:  Prythee,  what  doctor  is  there  now  in  the  city? 
For  their  pay  is  no  longer  anything  worth,  nor  their  art. 

Blep. :    Let  us  cast  about. 

Chrem.:    Nay,  there  is  not  one. 

Blep. :    I  believe  there  is  not. 

Chrem.:  Nay,  by  Zeus,  the  best  plan  is  to  do  what  I  have  been 
long  preparing — (to  conduct  him  [Ploutos] )  to  the  temple  of 
Asklepios  [and]  make  him  lie  down  [there]. 

Chrem.:  Karion,  my  man,  you  must  bring  out  the  bed-clothes 
and  lead  Ploutos  himself  in  the  usual  way,  and  carry  everything 
else  that  is  ready  within. 

{Exeunt  omnes.) 


Chorus  of  Farthers.  What  is  the  matter.  Oh  thou  best  friend 
of — thyself?  For  you  seem  to  have  come  as  a  messenger  of  some 
good  news. 


GREEK  MEDICINE  59 

Karion!'  My  master  has  fared  most  prosperously,  or  rather 
Ploutos  himself.  For,  instead  of  being  a  blind  man,  he  has  been 
made  to  see  again,  and  his  pupils  are  clear-sighted,  as  he  has  met 
with  a  kindly  friend  in  Asklepios  the  Healer. 

Chorus.  You  give  me  reason  for  joy,  reason  for  shouts  of 
triumph. 

Karion.    Ye  have  reason  to  rejoice  whether  ye  wish  it  or  not. 

Chorus.  I  will  shout  aloud  for  Asklepios  of  the  goodly  children, 
the  great  light  to  mortals. 

•        *•••••••• 

Karion.  Well,  as  soon  as  ever  we  came  to  the  god,  leading  a 
man  then,  indeed,  most  miserable,  but  now  blessed  and  fortunate, 
if  any  other  is  so,  first  we  led  him  to  the  sea,  and  then  we  bathed 
him. 

Wife  of  Chremulos.  By  Zeus,  then  the  old  man  was  fortunate, 
bathing  in  the  cold  sea. 

Karion.  Then  we  went  to  the  sacred  enclosure  of  the  god.  And 
when  on  the  altar  the  cakes  and  offerings  were  dedicated  by  the 
flame  of  murky  Hephaistos,  we  laid  down  Ploutos,  as  was  proper; 
and  each  of  us  made  up  from  little  odds  and  ends  a  bed  for  himself. 

Wife.  Then  were  there  certain  others  beside  yourselves  wanting 
the  god  ? 

Karion.  Yes,  Neokleides,  for  one,  and  he  is  blind;  but  in 
stealing  has  far  overshot  those  who  can  see ;  and  there  were  many 
others  with  all  sorts  of  ailments.  But  when  the  minister  of  the 
deity  put  out  the  lights  and  told  us  to  go  to  sleep  and  said  that  we 
were  to  keep  silent,  if  any  of  us  perceived  a  noise,  we  all  lay  down 
in  an  orderly  manner.  And  I  was  unable  to  sleep,  for  my  attention 
was  arrested  by  a  certain  pitcher  of  porridge  a  little  way  off  from 
the  head  of  a  certain  old  woman,  and, I  strangely  desired  to  creep 
over  to  that  pitcher.  Then  I  looked  up  and  saw  the  priest  making 
a  clean  sweep  of  the  cakes  and  dried  figs  from  the  sacred  table. 
After  this  he  went  round  all  the  altars  in  a  circle  to  see  if  any 
cakes  were  left  anywhere.  Then  he  consecrated  them  into  a  certain 
wallet;  and  I,  believing  that  there  was  great  holiness  in  this 
proceeding,  rise  up  to  go  to  the  pitcher  of  porridge. 

Wife.  Oh  you  most  miserable  of  men,  were  you  not  afraid  of 
the  god? 

Karion.  Yes;  by  the  gods  I  was  afraid  lest  he  with  his  fillets 
should  reach  the  pitcher  before  me;  for  the  priest  had  already 

'  The  slave  of  Chremulos. 


60  GROWTH  OF  MEDICINE 

given  me  a  lesson.  But,  as  soon  as  ever  the  old  woman  perceived 
the  noise  I  made,  she  lifted  up  her  hand  over  the  pitcher  (to  protect 
it).  Then  I  hissed  and  seized  (her  hand)  by  the  teeth  as  if  I  were 
a  reddish-brown  snake.  But  she  at  once  drew  back  her  hand  again 
and  lay  down  peacefully,  rolling  herself  up.  And  then  I  at  once 
gulped  down  a  lot  of  the  porridge;  and  then,  when  I  was  fuU,  I 
jumped  up  again. 

Wife.    And  didn't  the  god  come  up  to  you? 

Karion.  Not  up  to  that  time.  After  this  I  at  once  covered 
myself  up,  being  afraid ;  but  he  made  a  complete  circuit  examining 
all  the  ailments  in  a  most  orderly  fashion ;  and  then  a  slave  set  by 
him  a  little  mortar  and  box  of  stone. 

Wife.     Of  stone  ? 

Karion.     No,  by  Zeus,  certainly  not, — at  least,  not  the  box. 

Wife.  To  the  deuce  with  you,  how  did  you  see  since  you  say 
you  were  covered  up  ? 

Karion.  Through  my  old  cloak;  for,  by  Zeus,  it  had  holes  not 
a  few.  First  of  all,  he  took  in  hand  to  pound  a  plaster  for  Neo- 
kleides,  and  he  threw  in  three  cloves  of  Tenian  garlic.  Then  he 
bruised  them  in  the  mortar,  mixing  therewith  the  acid  juice  of  the 
fig-tree  and  squill ;  then,  having  diluted  it  with  Sphettian  vinegar, 
he  turned  his  eyelids  inside  out  that  he  might  feel  more  pain,  and 
then  applied  the  mixture.  But  he,  squalling  and  bawling,  jumped 
up  and  was  running  away,  when  the  god  said  with  a  laugh : — * '  Sit 
down  there  now,  smeared  with  thy  plaster,  that  I  may  stop  thee 
from  going  to  the  Assembly,  having  for  once  a  real  excuse. ' ' 

Wife.    What  a  patriot  and  sage  the  god  is ! 

Karion.  After  that  he  sat  down  by  the  side  of  Ploutos,  and 
first  he  touched  his  head,  and  then,  taking  a  clean  towel,  he  wiped 
his  eyelids  all  round,  and  Panakeia  covered  his  head  and  all  his  face 
with  a  cloth  of  purple  dye ;  and  the  god  then  whistled.  Thereupon 
two  snakes  of  monstrous  size  darted  forth  from  the  temple. 

Wife.     Dear  Gods ! 

Karion.  And  these  two  (snakes)  having  quietly  glided  under 
the  crimson  cloth,  licked  his  eyelids  all  around,  methought.  And 
before  you  could  drink  ten  cups  of  wine,  my  mistress,  Ploutos 
stood  up  and  was  able  to  see :  and  I  clapped  my  hands  with  delight 
and  awoke  my  master.  And  the  god  suddenly  took  himself  off 
from  our  view  with  the  snakes  into  the  temple. 

If  one  examines  carefully  the  facts  connected  with  the 
Aesculapian  temple  treatment,  so  far  as  they  are  known 


GREEK  MEDICINE  61 

to  us,  one  cannot  fail  to  be  impressed  with  their  strong 
resemblance  to  what  has  been  the  experience  of  similar 
semi-religious  movements  in  more  recent  times,  not  only 
in  European  countries  but  also  in  the  United  States.  In 
all  of  them  there  may  be  found  a  kernel  of  true  religious 
belief,  and  no  candid  observer  can  deny  the  fact  that  many 
persons  have  been  benefited  thereby  both  in  body  and  in 
mind.  But,  sooner  or  later,  the  method  has  fallen  into 
disrepute,  either  because  it  was  employed  in  the  vain  hope 
that  it  might  accomplish  a  cure  which  surgical  means  alone 
could  effect,  or  else  because  unscrupulous  persons,  taking 
advantage  of  the  credulousness  of  those  associated  with 
the  movement,  utilized  it  for  their  own  selfish  advantage. 


CHAPTER  V 

THE  SIGNIFICANCE  OF  THE  SERPENT  IN  THE 
STATUES  AND  VOTIVE  OFFERINGS  EXPOSED 
TO  VIEW  IN  THE  AESCULAPIAN  TEMPLES 

Almost  every  important  gallery  of  sculpture  in  Europe 
possesses  at  least  one  marble  statue  of  Aesculapius,  and  in 
the  majority  of  these  the  god  is  represented  as  a  middle- 
aged  or  elderly  man  of  powerful  frame,  having  a  full  head 
of  hair  and  full  beard,  and  clothed  only  with  the  pallium 
or  mantle,  which  is  so  placed  as  to  leave  the  right  shoulder 
and  a  large  part  of  the  chest  uncovered.  He  holds  in  his 
right  hand  a  knotted  staff  around  which,  in  many  of  the 
statues,  is  coiled  a  serpent  whose  head  approaches  very 
closely  to  the  hand.  The  expression  of  the  god's  counte- 
nance is  strikingly  peaceful  and  serene,  yet  without  any 
evidence  of  weakness.  In  not  a  few  instances  other  animals 
are  represented  alongside  the  statue,  usually  at  the  god's 
feet — as,  for  example,  the  cook,  the  owl,  the  eagle,  the  hawk 
or  the  ram — and  occasionally  his  daughter  Hygieia  is 
shown  at  his  side  feeding  the  serpent.  The  cock  is  the 
symbol  of  watchfulness — a  physician  should  be  vigilant; 
the  owl  symbolizes  his  need  of  clearsightedness  and  of 
readiness  to  care  for  his  patients  in  the  night  as  well  as 
during  the  day;  the  eagle  has  a  penetrating  eye  and  it  is 
the  emblem  of  long  life — a  benefit  which  the  healing  art  is 
capable  of  procuring;  the  hawk  was  the  bird  consecrated 
to  Isis,  Queen  of  Egypt,  who  was  believed  by  the  Egyptians 
to  have  been  highly  skilled  in  medicine ;  and  the  ram  is  the 
symbol  of  dreams  and  divination.  Pliny  says  that  the 
patients  who  were  brought  to  the  temple  of  Aesculapius 
were  made  to  lie  down  at  night  wrapped  in  the  skin  of  a 


'-V 


HEAD  OF  THE 

MARBLE 

STATUE  OF 

THE  GOD 

AESCULAPIUS 

IN  THE 

NAPLES 

MUSEUM 


FIG.  4.    ANCIENT  STATUE  OF  THE 

GOD  AESCULAPIUS  IN  THE 

BERLIN  MUSEUM. 

(From  Hollander'.s  Plaslik  und  Medizin,  with 
the  author's  permission.) 


SIGNIFICANCE  OF  THE  SERPENT  63 

ram,  in  order  that  they  might  have  divine  dreams.  The 
presence  of  the  serpent  in  nearly  all  of  the  statues  of 
Aesculapius  is  explained  in  a  variety  of  ways.  Some  say 
that  this  reptile,  which  sheds  his  skin  once  a  year,  is 
emblematic  of  the  sick  person 's  need  to  acquire  a  new  body, 
or  at  least  cast  off  his  old  skin  in  the  same  manner  as  does 
the  snake.  Others  consider  the  serpent  as  merely  the 
symbol  of  wisdom,  as  it  is  admittedly  the  shrewdest  and 
most  cunning  of  all  animals.  In  a  few  instances  it  is 
represented  as  drinking  from  a  receptacle  held  in  the  hand 
of  Hygieia.  Perhaps  the  sculptor's  intention  here  was  to 
show  that  the  serpent,  although  the  wisest  of  all  animals, 
believed  that  he  might  add  to  his  stock  of  wisdom  by 
drinking  from  the  fountain  under  the  control  of  Aescula- 
pius, thus  conveying  the  impression  that  the  wisdom  of  the 
latter  was  greater  than  his  own.  But  all  these  interpre- 
tations are  too  subtle  for  the  uneducated  mind  to  appre- 
ciate at  a  glance.  They  fail  also  to  satisfy  our  preconceived 
ideas  of  what  such  a  statue  should  be — viz.,  a  memorial  of 
the  godlike  character  of  Aesculapius  and  of  the  priceless 
benefits  which  he  conferred  upon  his  fellow  men,  and,  at 
the  same  time,  an  object  which,  when  first  contemplated 
by  one  who  is  ill,  would  at  once  evoke  in  that  person  feelings 
of  perfect  confidence  in  the  ability  and  the  willingness  of 
the  god  represented  by  the  statue  to  effect  a  cure.  Some, 
perhaps  even  a  majority,  of  the  statues  thus  far  recovered 
from  the  ruins  of  the  different  Aesculapian  temples  cer- 
tainly fail  to  arouse  any  such  sentiments  in  the  minds  of 
ordinary  observers ;  but  there  are  others  which  do  in  some 
measure  accomplish  this,  and  among  the  number  the  statue 
which  may  be  seen  in  the  Berlin  Museum  ancj  of  which  a 
photographic  copy  (Fig.  4)  is  here  reproduced,  should 
certainly  be  included.  The  head  of  the  god  is  less  imposing 
and  the  expression  less  kindly  than  are  these  features  in 
some  of  the  other  statues  (see,  for  example.  Fig.  5),  but, 
to  offset  this,  the  serpent  represented  in  the  latter  is  of 
the  non-poisonous  variety.^  The  addition  of  such  a  harm- 
less creature  to  the  figure  representing  the  god  contributes 

1  To  save  space  the  head  of  the  god  alone  has  been  reproduced  in  Fig,  5. 


64  GROWTH  OF  MEDICINE 

nothing  to  the  power  of  the  statue  as  a  whole  to  impress 
the  people — i.e.,  the  uneducated  masses,  as,  for  example, 
the  peasants,  etc.  On  the  other  hand,  the  significance  of 
the  poisonous  snake  in  a  statue  of  this  character  will  be 
readily  appreciated  if  one  considers  the  fact  that  in  ancient 
times,  as  it  is  even  to-day  in  India,  the  loss  of  life  caused 
by  the  bites  of  poisonous  snakes  was  enormous.  In  the 
presence  of  such  a  fact,  therefore,  it  would  be  difficult  for 
a  sculptor  who  was  desirous  of  emphasizing  the  extraor- 
dinary healing  powers  of  his  hero  to  accomplish  this  more 
effectively  than  by  embodying  in  his  statue,  along  with 
other  impressive  features,  such  characters  as  would  show 
him  to  have  gained  the  mastery  over  that  terribly  fatal 
malady — the  bite  of  the  viper  and  of  the  still  more  deadly 
serpents  of  India  and  parts  of  Africa.  Although  we 
possess  no  facts  which  would  warrant  the  statement  that 
Aesculapius  had  been  particularly  successful  in  the  treat- 
ment of  this  form  of  poisoning,  these  temple  statues  furnish 
indirect  proof  of  a  strong  character  that  his  healing  power 
in  this  direction  had  been  very  great, — so  great,  indeed, 
as  to  have  been  largely  instrumental  in  winning  for  him 
the  appellation  of  a  god.  Such  a  striking  object,  especially 
when  its  more  important  features  were  commented  upon 
by  the  priest  who  accompanied  the  patient  on  his  or  her 
first  tour  of  inspection  of  temple  wonders,  could  scarcely 
have  failed  to  produce  a  very  deep  impression  upon  the 
imagination. 

In  the  illustration  which  has  here  been  reproduced 
(Fig.  4),  a  viper,  as  clearly  shown  by  the  shape  of  his  head 
and  neck  and  by  the  unusual  length  of  the  jaw,  has  twined 
himself  about  the  staff  and  is  close  to  the  god's  hand,  so 
close  that  in  an  instant's  time  the  fatal  bite  might  readily 
be  inflicted.  But  Aesculapius  shows  by  his  countenance,  by 
the  unconcerned  manner  in  which  he  allows  his  right  hand 
to  remain  near  the  serpent's  head,  and  by  the  easy  pose 
of  his  whole  body,  that  he  is  not  at  all  concerned  about  the 
danger  which  appears  to  threaten  his  life.  In  the  estima- 
tion of  the  ancient  Greeks  this  fearlessness  was  undoubt- 
edly  attributed   to   the    supernatural   power   which   they 


SIGNIFICANCE  OF  THE  SERPENT  65 

believed  Aesculapius  to  possess  over  dangerous  serpents 
as  well  as  over  diseases  of  all  kinds. 

So  far  as  now  appears,  all  the  statues  of  the  god  that 
have  been  dug  up  in  Greece  or  its  nearest  colonies  represent 
the  serpent  as  of  the  size  commonly  observed  in  that  part 
of  the  world.  HoUaender,  however,  furnishes  (on  page  118 
of  his  work)  an  illustration  which  represents — as  Ije 
believes — the  god  Aesculapius  in  the  presence  of  an 
enormous  snake,  evidently  a  python.  (  Fig.  Q.)  yAs  this 
variety  of  serpent  is  not  to  be  found  in  Greece,  or  indeed 
at  any  point  further  north  than  the  Mediterranean  coast 
of  Africa,  it  is  fair  to  assume  that  the  bas-relief  which 
depicts  this  scene  must  have  been  made  for  exhibition  in 
an  Asclepieion  located  at  Cyrene  or  at  the  relatively  near 
city  of  Alexandria,  where  patients,  who  were  more  or  less 
familiar  with  this  serpent  and  realized  its  power  of 
crushing  people  to  death,  would  have  occasion  to  witness 
this  suggestive  work  of  art.  And,  furthermore,  as  if  it  were 
for  the  express  purpose  of  emphasizing  the  great  protective 
power  of  the  god,  the  sculptor  has  introduced,  on  one  side 
of  the  scene,  the  figures  of  three  women,  two  young  children 
and  a  lamb.  The  women  nearest  to  the  monster  have 
folded  their  arms  and  do  not  manifest  the  least  sign  of  fear. 
The  children  also  appear  to  be  unaware  of  the  presence 
of  a  deadly  danger.  In  short,  the  proximity  of  the  god 
Aesculapius  has  instilled  into  the  minds  of  these  human 
beings  the  most  complete  sense  of  fearlessness ;  he  himself, 
as  in  the  case  of  the  statue  of  Aesculapius  shown  in  Fig.  4, 
exhibiting  a  complete  absence  of  fear  in  the  presence  of 
the  dangerous  monster.  Neither  death  by  poisoning  nor 
death  by  constriction  has  any  terrors  for  him  to  whom 
the  patient  is  about  to  appeal  for  relief  from  disease. 

That  pythons  were  a  terror  in  former  times  to  the  people 
who  inhabited  the  coast  regions  near  Cyrene  is  evident 
from  a  statement  which  Aristotle  makes  in  his  History 
of  Animals  (Book  VIII.,  Chapter  xxviii.).  It  reads  as 
follows : — 

In  Libya  (Africa)  the  serpents,  as  has  been  already  remarked, 
are  very  large.     For  some  persons  say  that,  as  they  sailed  along 


66  GROWTH  OF  MEDICINE 

the  coast,  they  saw  the  bones  of  many  oxen,  and  that  it  was  evident 
to  them  that  they  had  been  devoured  by  the  serpents.  And,  as 
the  ships  passed  on,  the  serpents  attacked  the  triremes,  and  some 
of  them  threw  themselves  upon  one  of  the  triremes  and  overturned 
it. 


CHAPTER  VI 

THE  BEGINNINGS  OF  A  RATIONAL  SYSTEM  OF 
MEDICINE  IN  GREECE 

With  the  lapse  of  time  the  religious  and  mystical  features 
of  the  treatment  carried  on  at  the  Asclepieia  gave  place, 
more  and  more,  to  rational  methods,  and  eventually — it 
is  scarcely  possible  to  mention  a  date,  but  probably  not 
many  years  before  the  Hippocratic  period — these  institu- 
tions became  centres  for  the  spread  of  medical  knowledge 
of  the  most  practical  kind.  This  is  particularly  true  of  the 
Asclepieion  at  Cos,  where  Hippocrates  is  believed  to  have 
received  his  medical  training.  It  is  interesting  to  note  that 
the  ijaystical  features  of  the  temple  treatment — features 
which  certainly  did  not  originate  with  Aesculapius  himself 
or  with  his  sons,  Machaon  and  Podalirius — eventually 
proved  powerless  to  stay  the  slow  but  sure  advance  of 
sound  medical  knowledge.  Even  during  the  period  when 
these  false  elements  seemed  to  be  most  strongly  rooted 
in  the  temple  methods,  there  were  forces  at  work  which 
in  due  time  deprived  them  of  much  of  their  pernicious 
power.  This  result  was  inevitable,  for  an  organization 
which,  in  order  to  prosper  in  its  work  of  doing  good  to 
humanity,  depended  upon  the  natural  superstitiousness  of 
the  people,  could  not  possibly  thrive  for  an  indefinite 
length  of  time.  That  the  evil  results  did  not  develop  sooner 
than  they  did  simply  shows  how  powerful  and  stubborn  is 
the  force  of  superstition.  In  the  absence  of  trustworthy 
historical  evidence,  hypothetical  statements  only  can  be 
brought  forward,  but  there  can  scarcely  be  any  doubt  but 
that  a  genuine  belief  in  the  power  of  Aesculapius  (deified) 
to  cure  disease  and  restore  health  persisted  for  centuries. 

The  custom  of  recording  the  case  histories  on  tablets  or 


68  GROWTH  OF  MEDICINE 

on  the  colunms  of  the  temple, — for  at  this  period  writing 
was  in  general  use, — and  also  that  of  dedicating  to  the  god 
images  which  represented  (sometimes  with  a  remarkable 
degree  of  truthfulness)  the  pathological  condition  for 
which  the  patient  sought  relief,  contributed  very  greatly 
to  the  substitution  of  sound  learning  for  religious  mysticism 
and  poorly  concealed  humbuggery. 

Among  the  interesting  objects  which  may  be  seen  at  the 
Museum  of  the  History  of  Medicine  in  Jena,  Germany, 
there  are  several  of  these  terra-cotta  images  (votive 
offerings)  representing  pathological  conditions;  and 
among  them  the  writer  noticed  more  particularly  one 
which  reproduced  faithfully,  though  in  diminutive  size,  the 
appearances  presented  by  cancer  of  the  female  breast. 
(Fig.  7.)  There  were  also  a  very  carefully  modeled 
statuette  of  the  trunk  of  a  woman  affected  with  ascites, 
and  an  admirable  representation  of  a  case  of  facial 
paralysis.  (Fig.  8.)  These  objects  were  obtained  by 
Professor  Meyer-Steineg  on  the  occasion  of  a  recent  visit 
to  the  ruins  of  the  temple  of  Cos  and  other  similar  ruins 
in  Greece  and  Asia  Minor.  The  British  Museum  possesses 
many  objects  of  the  same  character. 

It  is  not  known  at  what  precise  date  the  iatreia,  or  small 
private  hospitals,  first  made  their  appearance,  but  it  was 
about  the  time  when  the  religious  character  of  the  thera- 
peutic work  done  in  the  Asclepieia  gave  place  to  treatment 
of  a  more  distinctly  medical  character.  Then,  in  addition 
to  these  iatreia,  there  were  schools  for  gladiators  and 
institutions  in  which  gymnastic  exercises  were  zealously 
cultivated ;  and  in  these  places  there  was  a  frequent  demand 
for  advice  in  regard  to  questions  of  diet,  and  for  surgical 
aid  in  the  setting  of  broken  bones,  the  reducing  of  dis- 
locations, and  the  curing  of  bruises  and  sprains.  As  may 
readily  be  understood,  the  Asclepieia  could  not  furnish  the 
sort  of  professional  aid  which  these  institutions  needed, 
and  thus  a  further  stimulus  was  given  to  the  complete 
separation  of  the  two  kinds  of  medical  practice — that 
connected  with  the  temple  and  that  conducted  by  outside 
physicians. 


jS£BC-"w»- 


I  i(..  o.     BAS-RELlKi-   (;i-   AESCULAPIUS.  ACCOMPANIED  BY  WOMEN 

AND  CHILDREN,  IN  THE  PRESENCE  OF  AN 

ENORMOUS  SERPENT. 

The  original  is  in  the  National  Museum  at  Athens. 


FIG.  7.    FEMALE  BUST  SHOWING  CANCER  OF  ONE  BREAST. 
(Courtesy  of  Prof.  Dr.  Meyer-Steineg,  of  Jena,  Germany.) 


BEGINNINGS  OF  A  RATIONAL  SYSTEM       69 

In  Plato's  ''Republic"  (Book  III.,  Chapter  15)  mention 
is  made  of  a  certain  Herodicus  (of  Selymbria;  about 
450  B.  C.)  who  effected  many  cures  by  a  method  of  treat- 
ment which  combined  athletic  exercises  with  dieting.  He 
gained  considerable  celebrity  in  this  way,  and  is  undoubt- 
edly entitled  to  the  credit  of  having  been  the  first  to  call 
serious  attention  to  the  value  of  this  plan  of  treating 
certain  maladies.  But,  unfortunately,  he  made  use  of  it 
in  not  a  few  instances  where  it  proved  harmful  rather  than 
beneficial  to  the  patient,  and  thus  brought  discredit  upon 
the  method. 

Already  previous  to  the  time  at  which  the  changes 
mentioned  above  took  place,  there  had  occurred  still  other 
changes  in  the  character  and  practice  of  medicine.  The 
business  of  cutting  for  stone  in  the  bladder,  for  example, 
had  been  left  entirely  in  the  hands  of  men  who  made  a 
specialty  of  this  branch  of  medicine — men  who  might 
truthfully  be  called  medical  artisans.  Then  there  was 
another  class  of  men  who  devoted  their  energies  to  col- 
lecting medicinal  roots  and  plants.  They  were  a  necessity 
to  physicians,  and  constituted  the  first  representatives  of 
the  modern  apothecary.  Still  another  change  in  the  status 
of  the  Greek  physicians  had  been  slowly  developing 
throughout  this  pre-Hippocratic  period,  a  change  which 
tended  more  and  more  to  make  them  men  of  self-reliance 
and  of  considerable  importance  in  their  respective  com- 
munities, and  which  indicated  very  clearly  that  they  were 
steadily  growing  in  skill  and  breadth  of  knowledge.  As 
evidence  of  the  correctness  of  this  statement  it  is  sufficient 
to  mention  the  fact  that  Greek  physicians  had  established 
so  good  a  reputation  that  they  were  frequently  called  to 
see  important  cases  at  a  great  distance — in  Egypt,  in 
Persia,  etc.  But  before  further  consideration  is  given  to 
this  subject  of  the  development  of  the  Greek  physician 
during  the  period  immediately  preceding  the  appearance 
of  the  Hippocratic  writings,  it  seems  advisable  to  say  a 
few  words  concerning  the  facilities  for  medical  instruction 
which  were  available  at  that  time. 

Medical  Instruction  in  Connection  with  the  Asclepieia. — 


70  GROWTH  OF  MEDICINE 

It  does  not  appear  clearly  in  any  of  the  published  descrip- 
tions of  these  ancient  Greek  sanatoria  just  what  were  the 
relations  between  the  priests  and  the  men  who  utilized  all 
this  rich  clinical  material — records  of  all  sorts  of  diseases, 
and  the  means  (other  than  religious)  employed  in  treating 
them,  pictures  or  plastic  reproductions  of  the  visible 
pathological  lesions,  etc. — for  the  purpose  of  instructing 
the  younger  men  who  contemplated  engaging  in  the 
practice  of  medicine.  The  modern  teachers  of  the  art  know 
very  well  how  difficult  is  the  task  of  combining  in  a  satis- 
factory manner  these  two  things — the  safeguarding  of  the 
patient's  interests  and  the  utilization  of  their  maladies  as 
object  lessons  for  men  who  are  preparing  to  cure  or  relieve 
the  bodily  ills  of  those  who  may  at  some  future  moment 
need  their  professional  services.  To  them,  therefore,  it 
would  be  a  matter  of  very  great  interest  to  learn  how 
this  difficult  problem  had  been  solved  nearly  twenty-five 
hundred  years  ago.  But,  unfortunately,  no  satisfactory 
data  upon  which  a  trustworthy  account  might  be  founded 
are  obtainable,  and  we  are  obliged  to  fall  back  upon  such 
aid  as  our  imagination  may  furnish.  From  Puschmann's 
work  on  medical  teaching  in  ancient  times  the  following 
statement  relating  to  the  subject  has  been  taken : — 

The  priests  in  the  Aesculapian  temples  were  not,  as  is  generally 
assumed,  physicians  in  the  ordinary  sense.  They  may  have 
acquired  some  knowledge  of  the  art,  and  they  may  even  in  some 
instances  have  been  regularly  trained  physicians,  but  the  important 
fact  remains  that  they  wished  it  to  be  understood  that  the  treatment 
carried  out  in  the  temple  was  in  accordance  with  revelations  made 
to  them  by  the  god  Aesculapius,  and  not  the  mere  fruit  of  human 
knowledge.  Consequently  the  intervention  of  regular  physicians 
in  the  temple  management  of  the  sick  must  have  appeared  to  them 
quite  superfluous.  For  this  reason,  therefore,  it  is  not  likely  that 
there  existed,  on  the  part  of  either  the  temple  priests  or  the 
physicians,  any  feeling  of  animosity  or  opposition.  It  is  more 
likely  that  the  contrary  was  the  case,  for  the  evidence  shows  that 
the  physicians — the  Asclepiadae — paid  most  humble  reverence  to 
the  sacred  relics  of  Aesculapius,  and  placed  the  most  implicit 
confidence  in  the  opinions  which  he  was  supposed  to  give  in 
desperate  cases. 


70  - 


FIG.  8.    PARALYSIS  OF  THE  LEFT 
FACIAL  NERVE. 

(Courtesy  of  Prof.  Dr.  Meyer-Steinegr,  Jenaer  medi- 
zinisch-hislorische  Beiirage,  Heft  2,  1912.) 


BEGINNINGS  OF  A  RATIONAL  SYSTEM       71 

While  Puschmann  does  not  say  to  what  period  in  the 
history  of  these  temples  his  statement  applies,  it  is  safe 
to  assume  that  he  had  in  mind  only  the  earlier  stages. 
When  the  systematic  teachings  of  medical  pupils  began, 
those  physicians  who  gave  the  instruction — ^viz.,  the  Ascle- 
piadae  who  were  not  at  the  same  time  priests — took  up  their 
abode  somewhere  in  the  neighborhood  of  the  temple.  Thus, 
medical  schools  were  formed  at  different  places,  those  of 
Rhodes,  Crotone,  Cyrene,  Cos  and  Cnidus  attaining  the 
greatest  celebrity.  The  pupil  paid  a  fee  for  his  instruction, 
and  when  his  training  was  believed  to  be  completed  he  was 
admitted  into  the  association  or  brotherhood  of  the 
Asclepiadae  upon  taking  the  following  oath,  which  for  ages 
past  has  been  known  as  **The  Hippocratic  Oath,'*  but 
which  is  now  believed  to  have  been  formulated  long  before 
the  time  of  Hippocrates : — 

THE  HIPPOCRATIC  OATH 

I  swear  by  Apollo  the  Physician  and  Aesculapius,  and  Hygieia 
and  Panacea  and  all  the  gods  and  all  the  goddesses — and  I  make 
them  my  judges — that  this  mine  oath  and  this  my  written  engage- 
ment I  will  fulfil  as  far  as  power  and  discernment  shall  be  mine. 

Him  who  taught  me  this  art  I  will  esteem  even  as  I  do  my 
parents;  he  shall  partake  of  my  livelihood,  and,  if  in  want,  shall 
share  my  goods.  I  will  regard  his  issue  as  my  brothers  and  will 
teach  them  this  art  without  fee  or  written  engagement  if  they  shall 
wish  to  learn  it. 

I  will  give  instruction  by  precept,  by  discourse,  and  in  all  other 
ways,  to  my  own  sons,  to  those  of  him  who  taught  me,  to  disciples 
bound  by  written  engagements  and  sworn  according  to  medical 
law,  and  to  no  other  person. 

So  far  as  power  and  discernment  shall  be  mine,  I  will  carry  out 
regimen  for  the  benefit  of  the  sick  and  will  keep  them  from  harm 
and  wrong.  To  none  will  I  give  a  deadly  drug  even  if  solicited, 
nor  offer  counsel  to  such  an  end ;  likewise  to  no  woman  will  I  give 
a  destructive  suppository;  but  guiltless  and  hallowed  will  I  keep 
my  life  and  mine  art.  I  will  cut  no  one  whatever  for  the  stone, 
but  will  give  way  to  those  who  work  at  this  practice. 

Into  whatsoever  houses  I  shall  enter  I  will  go  for  the  benefit 
of  the  sick,  holding  aloof  from  all  voluntary  wrong  and  corruption, 
including  venereal  acts  upon  the  bodies  of  females  and  males 


72  GROWTH  OF  MEDICINE 

whether  free  or  slaves.  Whatsoever  in  my  practice  or  not  in  my 
practice  I  shall  see  or  hear  amid  the  lives  of  men  which  ought  not 
to  be  noised  abroad — as  to  this  I  will  keep  silence,  holding  such 
things  unfitting  to  be  spoken. 

And  now  if  I  shall  fulfil  this  oath  and  break  it  not,  may  the 
fruits  of  life  and  of  art  be  mine,  may  I  be  honored  of  all  men  for 
all  time ;  the  opposite  if  I  shall  transgress  and  be  forsworn. 

(Translated  from  the  Greek  by  the  late  John  G.  Curtis,  M.D.,  of 
New  York.) 

While  at  first,  according  to  Puschmann,  many  physicians 
did  not  belong  to  the  Aesculapian  Brotherhood,  there  came 
a  time  when  all  were  known  as  Asclepiadae. 

Influence  of  the  Schools  of  Philosophy  on  the  Growth  of 
Medical  Knowledge. — About  the  beginning  of  the  sixth 
century  B.  C.  there  developed,  in  Greece  and  its  colonies, 
schools  of  philosophy  which  exerted  a  most  excellent 
influence  upon  the  growth  of  medicine.  The  first  of  these 
was  the  one  known  as  the  Ionian  School,  whose  founders 
and  chief  representatives  were  Thales,  of  Miletus  in  Ionia 
(born  in  640,  died  in  548  B.  C),  and  his  pupils  Anaximander 
and  Anaximenes.  The  guiding  principle  of  these  men  was 
to  study  natural  phenomena  and  to  learn,  if  possible,  their 
causes  and  the  laws  of  their  action.  Physiology,  therefore, 
became  one  of  their  special  studies,  and  thus  they  con- 
tributed to  the  laying  of  one  of  the  most  important 
foundation-stones  of  medicine.  Thanks  to  the  good 
quality  of  the  work  of  instruction  that  had  thus  far  been 
carried  on  at  Cos,  Cnidus,  and  other  Asclepieia,  medicine 
had  by  this  time  reached  a  sufficient  degree  of  development 
for  its  devotees  to  derive  a  full  measure  of  benefit  from 
the  new  teaching  of  the  philosophers.  Well  grounded  in 
the  observation  of  disease  in  its  different  forms  and  modes 
of  behavior,  and  also  familiarized  with  the  ordinary 
methods  of  treatment,  these  physicians  needed  to  be  shown 
a  new  route  along  which  they  might  advance  to  greater 
heights  of  knowledge,  and  they  also  needed  to  be  stimu- 
lated to  further  endeavor.  The  introduction  of  the  new 
school  accomplished  both  of  these  purposes.  It  taught  the 
men  of  the  older  organizations  that  they  must  make  much 


BEGINNINGS  OF  A  RATIONAL  SYSTEM       73 

greater  use  of  their  reasoning  powers  than  they  had 
hitherto  done,  and  at  the  same  time,  through  the  creation 
of  a  group  of  rival  physicians,  it  supplied  them  with  the 
required  stimulus.  Another  important  school  of  philosophy 
was  that  known  as  the  Eleatic  School,  which  flourished  at 
Elea,  in  Lower  Italy,  its  leaders  being  natives  of  that  city. 
The  most  prominent  men  connected  with  this  school  were 
Parmenides  (born  about  540  B.  C.)  and  Xenophanes  of 
Colophon,  in  Asia  Minor,  whose  contributions  to  mental 
science  formed  the  basis  of  Plato's  metaphysics. 

The  period  roughly  embraced  between  the  years  500  and 
300  B.  C.  represents  the  most  brilliant  age  of  Greek 
intellectual  and  artistic  activity.  During  this  time  there 
came  into  prominence  such  philosophers,  historians,  poets, 
physicians,  artists  and  generals  of  armies  as  had  never 
before  been  marshaled  in  historic  array  in  so  rapid 
succession.  Even  at  this  late  day  the  names  of  these  great 
men  are  almost  household  words — such  names,  for  example, 
as  Pythagoras,  Alcmaeon,  Anaxagoras,  Aristotle,  Plato, 
Socrates,  Sophocles,  Aeschylus,  Euripides,  Aristophanes, 
Pindar,  Xenophon,  Demosthenes,  Democedes,  Hippocrates 
the  Great,  Phidias,  Praxiteles,  Zeuxis,  Apelles,  Darius  I., 
Alexander  the  Great,  and  many  others  of  almost  equal 
celebrity.  During  the  centuries  immediately  preceding 
this  golden  age  of  Greek  history,  there  seem  to  have 
been  very  few  men  of  great  merit  in  any  of  the  branches  of 
learning  or  in  the  fields  of  war  or  art,  but  this  impression 
is  certainly  false.  It  is  doubtless  to  be  explained  by  the 
fact  that  large  quantities  of  documentary  evidence  relating 
to  these  years  have  been  entirely  lost.  Daniel  Le  Clerc, 
for  instance,  states^  that,  of  the  separate  histories  of  the 
descendants  of  Aesculapius  which  were  written  by  Eratos- 
thenes, Pherecydes,  ApoUodorus,  Arius  of  Tarsus  and 
Polyanthus  of  Cyrene,  not  one  has  come  down  to  our 
time.  If,  then,  in  the  single  department  of  medicine, 
the  destruction  of  documentary  evidence  was  as  great  as 
is  here  represented,  how  enormous  must  have  been  the 
loss  of  precious  historical  materials  in  all  the  departments 

1  Histoire  de  la  Medecine,  Amsterdam,  1723. 


74  GROWTH  OF  MEDICINE 

of  human  activity  taken  together.  We  may,  therefore, 
safely  assume  that  this  golden  age,  which  lasted  only  about 
two  hundred  years,  represents  simply  the  culmination  of 
an  even  longer  period  of  slow  but  steady  development, 
a  period  of  creditable  though  perhaps  less  brilliant 
achievements. 

Of  the  names  mentioned  above  there  are  several  that 
belong  to  men  who  were  in  various  ways  connected  with  the 
early  history  of  medicine.  Pythagoras,  for  example,  is 
said  to  have  been  one  of  the  first  among  the  Greek  philoso- 
phers to  exert  a  strong  and  double  impression  upon  the 
medical  teaching  of  that  period.  He  was  born  in  the  Island 
of  Samos,  near  the  coast  of  Asia  Minor,  about  the  year 
575  B.  C.  After  spending  several  years  in  Egypt  for 
purposes  of  study,  and  probably  visiting  Babylon,  at'  that 
time  a  great  centre  of  learning  and  of  artistic  cultivation, 
he  established  at  Crotona,  in  the  south  of  Italy,  a  schooP 
where  natural  philosophy,  mathematics,  acoustics,  etc., 
were  taught.  He  also  devoted  some  attention  to  anatomy, 
to  embryology,  to  physiology  and  to  therapeutics.  Accord- 
ing to  his  views  of  what  constituted  hygienic  living  a  man 
should  accustom  himself  to  a  diet  of  the  simplest  character, 
without  meat.  Pythagoras  was  a  believer  in  the  Chaldean 
doctrine  that  the  uneven  numbers  possess  a  more  important 
significance  than  the  even,  and  that  the  number  seven  in 
particular  has  a  special  relationship  to  the  phenomena 
of  certain  diseases;  the  crisis  frequently  falling  on  the 
seventh,  fourteenth,  or  twenty-first  day.  Galen,  it  is  said, 
expressed  surprise  that  a  man  as  sensible  and  learned  as 
Pythagoras  should  have  paid  any  attention  to  such  trifles. 
Not  a  few  of  the  disciples  of  Pythagoras  were  physicians, 

2  The  word  ' '  school, ' '  when  employed  in  the  strictly  modern  sense  of  that 
term,  means  an  establishment  regularly  organized  for  the  purpose  of  giving 
instruction.  Here,  however,  it  is  intended  to  signify  simply  that  certain  places, 
like  Cos,  Crotona,  Cnidus,  etc.,  had  become  the  rendezvous  of  men  who  desired 
to  cultivate — some  as  teachers,  others  as  disciples  or  pupils — certain  branches 
of  knowledge,  or  certain  doctrines.  At  a  later  period  (third  century  B.  C.) 
there  was  established  at  Alexandria,  Egypt,  a  well-organized  school  of  medi- 
cine closely  resembling  those  of  modern  times. 


BEGINNINGS  OF  A  RATIONAL  SYSTEM       75 

and  when  the  brotherhood  (if  such  it  may  be  called)  broke 
up,  as  it  did  in  the  fifth  century  B.  C,  these  men  traveled 
about  from  one  Grecian  city  to  another;  from  which  fact 
they  were  given  the  name  of  *  *  periodeuts "  or  ambulant 
physicians.  Crotona  was  also  celebrated  as  the  birthplace 
of  Milo,  the  athlete. 

Democedes,  who  was  a  contemporary  of  Pythagoras,  but 
not  one  of  his  disciples,  was  a  native  of  Crotona.  Dion 
Cassius,  the  author  of  a  Roman  history,  ranks  him  and 
Hippocrates  as  the  two  most  eminent  physicians  of 
antiquity.  Daremberg,  who  derived  his  facts  from  the 
works  of  Herodotus,  gives  the  following  account  of  the 
adventures  of  Democedes : — 

Being  unable  to  bear  any  longer  the  frequent  anger  and  harsh 
treatment  of  his  father,  Calliphon,  Democedes  left  Crotona,  and 
settled  in  practice  at  Aegina,  on  the  Saronic  Gulf,  not  far  from 
Athens.  Almost  from  the  very  start  he  attained  marked  success, 
and  already  in  the  second  year  of  his  residence  in  Aegina  he  was 
made  the  recipient  of  a  pension  of  one  talent  (equal  to  about  £240. 
or  $1200.)  out  of  the  public  treasury.  During  the  following  year 
he  was  induced,  by  the  offer  of  a  larger  pension  (100  minae,  or 
about  $3000.)  to  settle  in  Athens;  and,  a  year  later,  he  accepted 
a  still  larger  remuneration  from  Polycrates,  the  tyrant  of  Samos. 
Having  accompanied  the  latter  on  a  trip  to  Sardis,  the  capital  of 
Lydia,  in  Asia  Minor,  he  fell  a  prisoner  into  the  hands  of  the 
governor  of  that  city,  and  was  made  by  him  a  slave.  Not  long 
afterward  Darius  gained  possession  of  this  governor's  or  satrap's 
property,  including  all  his  slaves;  and  thus,  despite  all  his  efforts 
to  conceal  his  profession  through  fear  that  a  knowledge  of  it  on 
the  part  of  the  king  might  prolong  his  bondage  indefinitely, 
Democedes  was  unable  to  do  so.  The  discovery  came  about  in  the 
following  manner.  During  a  hunting  trip  Darius  broke  his  ankle. 
He  called  to  his  assistance  the  court  physicians,  who  were  esteemed 
the  most  skilful  that  could  be  found  in  all  Egypt,  but  they  failed 
to  give  him  relief.  By  the  violence  of  their  manipulations  they 
rather  made  matters  worse.  For  seven  days  and  nights  his 
sufferings  were  so  great  that  he  was  unable  to  obtain  any  sleep. 
Finally,  on  the  eighth  day,  one  of  the  court  attendants  having  told 
Darius  that  there  was  a  Greek  physician  among  the  slaves, 
Democedes  was  sent  for,  and  he  appeared  before  the  king  clad  in 


76  GROWTH  OF  MEDICINE 

rags  and  with  chains  on  his  ankles.  When  asked  whether  he  knew 
anything  about  medicine  he  denied  such  knowledge,  being  fearful 
that  the  discovery  of  the  truth  about  himself  would  stand  in  the 
way  of  his  ever  getting  back  to  Greece.  Darius,  perceiving  that  he 
was  dissimulating,  ordered  the  attendants  to  fetch  the  whips  and 
pinchers.  Whereupon  Democedes  made  up  his  mind  that  he  had 
better  confess  the  truth.  He  accordingly  told  the  king  that,  while 
not  possessing  a  thorough  knowledge  of  the  healing  art,  long 
association  with  a  physician  had  familiarized  him  more  or  less 
with  the  subject.  The  king  then  asked  him  to  take  charge  of  the 
case.  Democedes,  following  the  treatment  adopted  by  the  Greek 
physicians  in  similar  conditions,  applied  soothing  remedies  and 
soon  succeeded  in  procuring  sleep  for  the  suffering  king.  Event- 
ually he  obtained  a  complete  cure,  and  Darius,  who  had  made  up 
his  mind  that  he  would  never  again  be  able  to  use  his  limb,  was 
naturally  delighted  with  the  result.  He  loaded  Democedes  with 
gifts,  and,  being  charmed  with  his  conversation,  made  him  sit  at 
the  royal  table  and  did  everything  possible  to  render  court  life 
attractive;  but  liberty  was  denied  him,  which  was  the  one  thing 
that  Democedes  most  ardently  desired.  The  only  use  which  the 
latter  made  of  the  great  influence  which  he  had  obtained  over 
Darius  was  to  save  the  Egyptian  physicians  from  the  death  by 
crucifixion  which  the  king  had  decided  to  inflict  upon  them  for 
their  lack  of  skill. 

The  means  of  escape  finally  presented  themselves  to  Democedes 
in  a  most  unexpected  manner.  Atossa,  who  was  the  wife  of  Darius 
and  also  the  daughter  of  Cyrus,  was  afflicted  with  a  swelling  of 
the  breast  which  developed  into  an  abscess  and  began  to  burrow 
into  the  neighboring  tissues.  After,  for  a  time,  concealing  the 
trouble  through  a  sense  of  false  modesty,  she  made  up  her  mind 
to  consult  Democedes.  He  had  the  good  fortune  to  cure  her  of 
this  malady  in  a  relatively  short  time.  As  preparations  were  then 
being  made  to  send  a  number  of  spies  to  Greece  with  instructions 
to  examine  the  coast  carefully  for  the  purpose  of  determining  at 
what  points  the  defenses  were  sufficiently  weak  to  render  an  attack 
by  the  Persians  reasonably  sure  of  success,  Democedes  asked 
permission  of  Darius  to  accompany  these  men  as  their  guide.  His 
request  was  granted;  and,  as  soon  as  the  expedition  reached 
Tarentum  in  Calabria,  he  delivered  the  Persian  spies  into  the 
hands  of  Aristophilides,  the  king  of  that  country,  and  then  fled 
in  all  haste  to  Crotona,  his  native  city.  Shortly  afterward  these 
Persians,  having  been  set  at  liberty  by  Aristophilides,  made  the 


BEGINNINGS  OF  A  RATIONAL  SYSTEM       77 

attempt  to  capture  Democedes  and  carry  him  off  by  main  force, 
but  the  citizens  of  Crotona  thwarted  the  attempt  and  compelled 
the  men  to  return  to  Asia.  Democedes  then  married  the  daughter 
of  Milo,  the  athlete,  and  history  furnishes  no  information  regarding 
the  subsequent  career  of  this  extraordinary  man. 

Daremberg  calls  attention  to  certain  excellent  proverbs 
which  may  be  found  in  the  writings  of  the  Greek  poets  and 
which  are  of  some  interest  to  physicians.  The  following 
may  serve  as  examples  of  those  most  widely  known : — * 

Joy  is  the  best  physician  for  fatigue. 

(Pindar,  522-442  B.  C.) 

The  good  physician  is  he  who  knows  how  to  employ  the  right 
remedies  at  the  proper  time ;  the  poor  one,  he  who,  in  the  presence 
of  a  serious  illness,  loses  his  courage,  becomes  flustered,  and  is 
unable  to  devise  any  helpful  method  of  treatment. 

(Aeschylus,  525-456  B.  C.) 

Physician,  heal  thyself. 

(Euripides,  400-406  B.  C.) 


Advice  given  to  Phaedra  by  her  nurse  :- 


If  thou  hast  some  ailment  which  thou  dost  not  care  to  reveal  to 
men,  here  are  women  who  are  competent  to  treat  the  condition 
properly. 

(Euripides.) 

Sleep  is  the  physician  of  pain, 
and 

Death  is  the  supreme  healer  of  maladies. 

(Sophocles,  495-406  B.  C.) 

In  Plato's  writings  there  are  to  be  found  a  few  passages 
in  which  this  philosopher  gives  his  views  in  regard  to 
certain  matters  that  are  not  without  interest  to  modern 
physicians.     The  following  extracts  are  of  this  nature: — 

There  is  not  then,  my  friend,  any  office  among  the  whole  inhabi- 
tants of  the  city  peculiar  to  the  woman,  considered  as  a  woman, 

3  All  of  these  are  translations  from  the  French. 


78  GROWTH  OF  MEDICINE 

nor  to  the  man,  considered  as  a  man;  but  the  geniuses  are 
indiscriminately  diffused  through  both:  the  woman  is  naturally- 
fitted  for  sharing  in  all  offices,  and  so  is  the  man;  but  in  all  the 
woman  is  weaker  than  the  man. 

Perfectly  so. 

Shall  we  then  commit  everything  to  the  care  of  the  men,  and 
nothing  to  the  care  of  the  women  ? 

How  shall  we  do  so  ? 

It  is  therefore,  I  imagine,  as  we  say,  that  one  woman,  too,  is 
fitted  by  natural  genius  for  being  a  physician,  and  another  is  not ; 
one  is  naturally  a  musician,  and  another  is  not. 

(From  "The  Republic"  of  Plato,  translated  by  Spens.) 

But  tell  me  with  reference  to  him  who,  accurately  speaking,  is 
a  physician,  whom  you  now  mentioned,  whether  he  is  a  gainer  of 
money  or  one  who  taketh  care  of  the  sick?  and  speak  of  him  who 
is  really  a  physician. 

One  who  taketh  care,  said  he,  of  the  sick. 

*********** 

Why  then,  said  I,  no  physician  as  far  as  he  is  a  physician,  con- 
siders what  is  advantageous  for  the  physician,  nor  enjoins  it,  but 
what  is  advantageous  for  the  sick;  for  it  hath  been  agreed  that 
the  accurate  physician  is  one  who  taketh  care  of  sick  bodies,  and 
not  an  amasser  of  wealth.    Hath  it  not  been  agreed  ? 

He  assented. 

(Plato,  428-547  B.  C,  translated  by  Spens.) 

But  Plato 's  knowledge  of  huinan  anatomy  and  physiology 
was  very  crude  and  in  some  instances  decidedly  fanciful. 
In  corroboration  of  this  statement  the  following  extract 
from  the  * '  Timaeus ' '  may  be  quoted : — 

And  on  this  account,  fearing  to  defile  the  Divine  nature  more 
than  was  absolutely  necessary,  they  [the  junior  gods]  lodged  man's 
mortal  portion  separately  from  the  Divine,  in  a  different  receptacle 
of  the  body;  forming  the  head  and  breast  and  placing  the  neck 
between,  as  an  isthmus  and  limit  to  separate  the  two  extremes. 

In  the  breast,  indeed,  and  what  is  called  the  thorax,  they  seated 
the  mortal  part  of  the  soul.  And  as  one  part  of  it  was  naturally 
better,  and  another  worse,  they  formed  the  cavity  of  the  thorax 
into  two  divisions  (resembling  the  separate  dwellings  of  our  men 
and  women),  placing  the  midriff  as  a  partition  between  them. 
That  part  of  the  soul,  therefore,  which  partakes  of  fortitude  and 


BEGINNINGS  OF  A  RATIONAL  SYSTEM       79 

spirit  and  loves  contention  they  seated  nearer  the  head  between 
the  midriff  and  the  neck ;  as  it  is  the  business  of  the  reason  to  unite 
with  it  in  forcibly  repressing  the  desires,  whenever  they  will  not 
obey  the  mandate  and  word  issuing  from  the  citadel  above. 

The  heart,  which  is  the  head  and  principle  of  the  veins  as  well 
as  the  fountain  of  the  blood  that  impetuously  circulates  through 
all  the  members,  they  placed  in  a  kind  of  sentry-house,  that,  in 
case  of  any  outburst  of  anger,  being  informed  by  the  reason  of  any 
evil  committed  in  its  members,  owing  either  to  some  foreign  cause, 
or  else  internal  passions,  it  (the  heart)  might  transmit  through 
all  its  channels  the  threatenings  and  exhortations  of  reason,  so 
as  once  more  to  reduce  the  body  to  perfect  obedience,  and  so  permit 
what  is  the  best  within  us  to  maintain  supreme  command. 

But  as  the  gods  foreknew,  with  respect  to  the  palpitation  of  the 
heart  under  the  dread  of  danger  and  the  excitement  of  passion, 
that  all  such  swellings  of  the  inflamed  spirit  would  be  produced 
by  fire,  they  formed  the  lungs  to  be  a  sort  of  protection  thereto; 
first  of  all,  soft  and  bloodless,  and  next  internally  provided  with 
cavities  perforated  like  a  sponge,  in  order  to  cool  the  breath  which 
they  receive,  and  give  the  heart  easy  respiration  and  repose  in 
its  excessive  heat.  On  this  account,  then,  they  led  the  channels 
of  the  windpipe  into  the  lungs,  which  they  placed  like  a  soft  cushion 
round  the  heart,  in  order  that  when  anger  rises  in  it  to  an  extreme 
height  it  might  fall  on  some  yielding  substance,  and,  so  getting 
cool,  yield  cheerfully  and  with  less  trouble  to  the  authority  of 
reason. 

(Plato's  "Timaeus,"  translated  by  Henry  Davis.) 

Alcmaeon,  Empedocles,  Diogenes  of  Apollonia,  Anaxa- 
goras  and  Pausanias,  whose  names  are  mentioned  above 
in  the  list  of  eminent  men  who  flourished  during  the  golden 
age  of  Greek  history,  are  entitled  to  further  consideration. 
Alcmaeon  of  Crotona  was  a  contemporary  and  disciple  of 
Pythagoras.  He  was  specially  devoted  to  the  study  of 
anatomy  and  physiology,  and  is  credited  with  the  distinc- 
tion of  having  been  the  first  person  to  dissect  animals  for 
the  purpose  of  learning  the  formation  of  the  different  parts 
of  their  bodies.  With  the  exception  of  a  few  fragments 
that  are  to  be  found  scattered  throughout  ancient  medical 
literature,  Alcmaeon 's  writings  have  all  been  lost.  The 
discovery   of  the   optic   nerve   is   credited   to   him,   and 


80  GROWTH  OF  MEDICINE 

Neuburger  states  that  he  deserves  still  greater  credit  for 
having  been  the  first  to  declare  that  the  brain  is  the  central 
organ  of  all  intellectual  activity. 

Of  all  the  disciples  of  Pythagoras,  Empedocles  attained 
the  greatest  celebrity.  He  flourished  about  444  B,  C,  his 
residence  being  at  Agrigentum,  in  Sicily.  Much  of  his 
reputation  appears  to  have  been  due  to  the  mystery  which 
surrounded  many  of*  his  actions.  He  was  even  reputed 
to  have  brought  again  to  life  persons  who  were  believed 
to  be  dead.  His  works  were  all  in  verse,  but  only  fragments 
have  come  down  to  us.  He  placed  the  seat  of  hearing  in 
the  labyrinth  of  the  temporal  bone.  His  death  occurred 
in  Peloponnesus  at  the  age  of  sixty,  as  the  result  of  an 
accident. 

Anaxagoras  was  born  at  Clazomenae,  in  Ionia,  500  B.  C. 
He  was  the  teacher  of  Euripides,  the  Athenian  poet,  and 
Pericles,  the  greatest  of  Athenian  statesmen.  He  and  his 
contemporary,  Diogenes  of  Apollonia,  in  Crete,  devoted  a 
great  deal  of  attention  to  the  study  of  anatomy.  They 
dissected  animals  and  made  some  genuine  discoveries; 
Anaxagoras  noting  the  existence  of  the  lateral  ventricles 
of  the  brain,  and  Diogenes  furnishing  a  description — ^very 
erroneous,  it  is  true — of  the  vascular  system  of  the  body. 
Puschmann  says  that,  according  to  Aristotle,  the  philoso- 
phers of  that  period  considered  the  study  of  man  and  his 
diseases  the  most  important  one  to  which  they  could 
devote  their  time  and  thoughts.  Many  of  them  indeed 
had  been  educated  as  physicians,  and  not  a  few  were  actual 
practitioners  of  medicine. 


CHAPTER  VII 
HIPPOCRATES  THE  GREAT 

Hippocrates  was  bom  in  460  B.  C.  in  the  city  of  Cos,  on 
the  island  of  the  same  name.  Both  his  father  and  grand- 
father were  eminent  physicians,  descendants  of  Aescu- 
lapius. On  his  mother's  side  he  traced  his  descent  from 
Hercules.  The  famous  painter,  Apelles,  also  hailed  from 
the  city  of  Cos.  To  distinguish  Hippocrates  from  an 
earlier  individual  of  the  same  name  he  was  called 
Hippocrates  II.,  or  the  Great.  He  is  said  to  have  received 
his  first  instruction  in  medicine  at  the  school  of  the 
Asclepiadae  in  his  native  city,  but  his  frequently  repeated 
and  very  favorable  comments  on  the  teachings  of  the 
Cnidian  schooP  have  led  some  to  believe  that  he  may  have 
received  a  part  of  his  medical  training  at  the  latter 
institution.  At  a  later  period  of  his  life  his  popularity  as 
a  teacher  of  medicine,  in  the  school  of  the  Asclepiadae  at 
Cos,  attracted  many  pupils  to  that  city.  In  accordance 
with  a  custom  which  prevailed  among  the  physicians  of 
ancient  Greece,  Hippocrate^,  at  the  beginning  of  his 
career,  spent  quite  a  long  time  in  Athens,  and  then  traveled 
about,  from  one  city  to  another,  in  the  character  of  a 
periodeutic  or  itinerant  physician.  In  this  way,  as  he 
himself  reports  in  some  of  his  writings,  he  visited  Thessaly, 
Thrace,  the  Island  of  Thasos,  Scythia,  the  countries 
bordering  on  the  Black  Sea,  and  even  Northern  Egypt. 
Owing  largely  to  domestic  troubles  he  left  his  home  in 
Cos,  during  the  latter  part  of  his  career,  and  removed 
to  Thessaly.    He  died  about  370  B.  C.  at  Larissa,  at  an 

1  The  city  of  Cnidus  was  situated  very  close  to  the  Island  of  Cos,  on  a 
peninsula  that  projects  from  the  coast  of  Caria,  Asia  Minor. 


82  GROWTH  OF  MEDICINE 

advanced  age.  Soranus  of  Ephesus,  the  celebrated 
obstetrician,  reported  that  in  his  time  (second  century 
A.  D.)  the  tomb  of  Hippocrates  was  still  standing,  and 
that  it  had  been  taken  possession  of  by  a  swarm  of  bees 
whose  honey  was  far-famed  for  its  efficacy  in  curing  ulcers 
of  the  mouth  in  children. 

Among  the  pupils  of  Hippocrates  were  his  two  sons, 
Draco  and  Thessalus,  and  his  son-in-law,  Polybus. 
Thessalus,  in  the  capacity  of  a  military  surgeon,  accom- 
panied Alcibiades  on  his  expedition  to  Sicily,  and  later 
in  his  career  he  served  as  private  physician  to  Archelaus, 
King  of  Macedonia.  It  is  also  believed  that  a  number  of 
the  writings  in  the  Hippocratic  collection  are  from  his 
pen.  On  the  other  hand,  it  is  a  well-established  fact  that 
Polybus  is  the  author  of  a  few  of  these  treatises.  When 
Hippocrates  gave  up  the  work  of  teaching,  his  son-in-law, 
who  was  at  that  time  engaged  in  private  practice  in  Cos, 
was  chosen  his  successor  in  the  school. 

Among  the  many  anecdotes  which  are  related  of  Hip- 
pocrates, there  is  one  which  may  with  propriety  be  repeated 
here : — 

On  the  occasion  of  a  visit  to  Abdera,  in  the  northern  part  of 
_  Thrace,  Hippocrates  was  requested  to  examine  into  the  mental 
condition  of  the  philosopher  Democritus,  who  was  thought  by  his 
narrow-minded  countrymen  to  be  insane.  Hippocrates  found  him 
deeply  engrossed  in  the  study  of  natural  philosophy  and  asked  him 
what  he  was  doing.  Democritus  replied  that  he  was  investigating 
the  foolishness  of  men.  Whereupon  Hippocrates  reported  that  he 
considered  Democritus  the  wisest  of  men.     (Pagel.) 

No  better  evidence  of  the  true  greatness  of  a  man  can  be 
furnished  than  that  which  is  afforded  by  the  praise  of  his 
contemporaries  in  the  same  rank  or  walk  of  life ;  and  when 
the  appreciation  comes  from  such  men  as  Plato  and 
Aristotle,  it  constitutes  an  absolute  guarantee  that  it  is 
well  and  honestly  earned.  To  Hippocrates  belongs  the 
singular  honor  of  having  won  unstinted  praise  from  both 
of  these  great  philosophers,  Aristotle  giving  him  the  title 
of  ''Hippocrates  the  Great,"  and  Plato  comparing  him 


HIPPOCRATES  THE  GREAT  83 

to  those  famous  sculptors,  Polyclytus  and  Phidias.  His 
writings  and  those  of  the  members  of  his  family  who  were 
associated  with  him  in  the  work  of  promoting  a  knowledge 
of  medicine  were  most  carefully  preserved  by  his  successors. 
When  the  Ptolemies  began  to  establish  libraries  at  Alex- 
andria, Egypt  (285  B.  C),  and  manifested  a  decided 
readiness  to  purchase  the  works  of  the  most  celebrated 
authors,  copies  of  the  Hippocratic  writings  were  among 
those  which  found  their  way  to  that  city.  This  eagerness 
on  the  part  of  the  Kings  of  Egypt  to  purchase  books  or 
manuscripts  stimulated  unscrupulous  persons  to  attribute 
to  celebrated  authors  not  a  few  of  these  works  which  they 
offered  for  sale.  The  librarians,  whose  duty  it  was  to 
guard  against  such  frauds,  were  not  sufficiently  well 
informed  to  prevent  them;  and  thus  there  were  accepted, 
as  genuine  productions,  a  few  books  which  could  not 
possibly  have  been  written  by  those  to  whom  they  were 
attributed.  The  collectiou  of  Hippocratic  writings  did  not 
escape  this  fate,  and  the  evil  was  also  further  aggravated 
by  the  fact  that  copyists  and  incompetent  editors  made  all 
sorts  of  emendations  and  additions  on  their  own  respon- 
sibility. Thus,  it  is  not  surprising  that  a  collection  which 
originally  contained  only  the  writings  of  Hippocrates  and 
his  immediate  family,  should  in  course  of  time  have  become 
expanded,  not  only  by  such  alterations  as  have  just  been 
described,  but  also  by  the  addition  of  entire  works  that  had 
been  written  by  others.  At  the  beginning  of  the  third 
century  B.  C,  the  Ptolemies  appointed  a  committee  of 
learned  men  in  Alexandria  to  examine  carefully  the 
treatises  reputed  to  be  the  work  of  Hippocrates  and  to 
make  a  collection  of  those  which  appeared  to  them  to  be 
genuine.  They  performed  this  task  to  the  best  of  their 
ability,  but  the  result  showed  that  they  lacked  the  necessary 
critical  powers;  and  consequently  during  the  past  2000 
years  repeated  attempts  have  been  made  to  do  what  they 
failed  to  accomplish,  but  these  efforts  have  only  succeeded 
in  part.  The  French  edition  prepared  by  Emile  Littre,  the 
distinguished  member  of  the  French  Academy  of  Medicine, 
and  published  in   the  years   1839-1861,   was,   until   quite 


84  GROWTH  OF  MEDICINE 

recently,  universally  accepted  as  embodying  the  best  results 
of  modern  research  and  criticism  with  regard  to  this 
difficult  question.  But  since  1861  other  scholars  have  been 
busily  engaged  in  perfecting  the  text  of  the  Hippocratic 
writings,  and  their  criticisms  and  suggestions  have  made 
it  possible  to  publish  a  German  version  of  this  great  work 
which  is  of  more  practical  value  to  physicians  than  that  of 
Littre,  which  forms  a  series  of  ten  large  volumes  and  is 
no  longer  easy  to  obtain.  On  the  other  hand,  the  German 
version  by  Robert  Fuchs  (Munich,  1895-1900),  in  three 
volumes  of  moderate  size,  while  in  no  respect  inferior  to 
the  famous  French  translation,  is  superior  to  it  in  several 
particulars:  it  is  better  adapted  to  the  needs  of  the 
ordinary  practitioner  of  medicine,  it  embodies  the  results 
of  the  excellent  critical  work  done  since  1861  {e.g.,  by 
Ermerins  of  Utrecht,  Daremberg  of  France,  and  Ilberg 
and  Kiihlewein  of  Germany),  and  it  costs  very  much  less 
than  its  French  predecessor  and  rival. 

As  regards  the  question  of  authenticity  of  the  treatises 
contained  in  the  work  known  as  *'The  Hippocratic  Writ- 
ings" the  most  important  thing  to  be  determined  is,  not 
whether  this  or  that  book  or  chapter  in  the  collection  was 
really  written  by  Hippocrates,  but  whether  the  work  in 
its  totality  gives  a  correct  and  fairly  complete  picture  of 
the  best  medical  thought  and  practice  of  the  period  during 
which  Hippocrates  lived;  and  to  this  question  a  decided 
answer  in  the  affirmative  may  be  given.  As  to  the  broad 
question  of  authenticity.  Max  Neuburger,  the  distinguished 
Viennese  author  of  the  latest  and  most  authoritative 
history  of  medicine,  thus  expresses  himself : — 

Notwithstanding  the  extremely  small  quantity  of  evidence  which 
the  so-called  ''Hippocratic  Writings"  themselves  furnish  as  to 
who  were  the  writers  of  the  individual  treatises  and  as  to  what 
Hippocrates  himself  actually  did  or  thought;  and  although  it  is 
true  that  portions  of  the  collection  often  contradict  one  another 
both  in  regard  to  questions  of  theory  and  also  in  regard  to  methods 
of  treatment,  one  fact  stands  out  conspicuously,  viz.,  that  the 
peculiar  character  of  these  writings  both  as  a  collection  and  taken 
separately,   not   only   gives   them   a   unique   position   in   medical 


HIPPOCRATES  THE  GREAT  85 

literature,  but  reveals  plainly  that  they  owe  their  origin  directly 
or  indirectly  to  the  powerful  influence  of  a  single  commanding 
personality. 

As  to  the  manner  of  teaching  medicine,  the  Hippocratic 
writings  show  that,  at  the  time  which  is  here  under  con- 
sideration, the  mystical  features  had  almost  completely 
disappeared.  The  science  was  now  taught  by  regular 
instructors,  who  agreed  for  a  stipulated  fee  to  take  charge 
of  the  pupil's  entire  training  from  the  beginning  to  the 
end  of  the  course.  Candidates  who  were  in  delicate  health 
were  discouraged  from  entering  upon  the  career  of  a 
physician,  and  those  who  had  completed  the  regular  course 
of  instruction  were  sent  out  into  the  world  equipped  with 
certain  general  principles  for  their  future  guidance  in 
actual  practice.  Some  of  these  bear  a  close  resemblance 
to  the  principles  of  a  similar  nature  which  had  been 
established  at  a  much  earlier  period  in  India.  For  example, 
the  importance  of  cleanliness  of  the  person  is  strongly 
emphasized.  Reticence,  as  well  as  courtesy,  is  classed  as 
one  of  the  virtues  of  a  good  physician. 

He  who  acts  hastily  and  does  not  take  sufiBcient  time  for 
consideration  is  sure  to  be  criticised  unfavorably.  If  he  breaks 
out  too  readily  into  laughter  he  will  be  thought  uncultivated. 

In  another  of  the  Hippocratic  writings  the  physician  is 
urged  not  to  indulge  in  too  much  small  talk,  but  to  confine 
his  conversation  as  much  as  possible  to  matters  relating 
to  the  treatment  of  the  disorder. 

In  his  business  dealings  the  physician,  like  a  genuine  philosopher, 
should  not  display  a  greed  for  money,  he  should  assume  a  modest 
and  dignified  attitude,  he  should  appear  quiet  and  calm,  and  his 
speech  should  be  simple  and  straightforward  and  free  from  all 
superstition. 

For  their  knowledge  of  human  anatomy  the  physicians 
of  that  period  were  obliged  to  depend  on  the  dissection  of 
animals.    Specimens  of  human  bones  were  of  course  easily 
accessible,  and  consequently  the  descriptions  which  are 


86  GROWTH  OF  MEDICINE     , 

given  of  these  structures  are  quite  accurate,  even  as 
regards  many  of  the  finer  details. 

It  would  be  a  very  difficult  matter  to  furnish  here,  within 
a  limited  space,  a  reasonably  clear  exposition  of  the  views 
held  by  Hippocrates  with  regard  to  human  physiology  and 
pathology.  Empedocles,  a  Greek  physician  and  high  priest 
of  Agrigentum,  in  Sicily,  who  was  born  about  490  B.  C, 
founded  a  system  of  philosophy  on  the  theory  that  the 
universe  is  made  up  of  four  elements — fire,  air,  earth  and 
water;  and  he  maintained  that  fire  is  the  essence  of  life, 
the  other  elemei^ts  forming  the  basis  of  matter.  It  was 
upon  this  system  that  Hippocrates  founded  his  own  theories 
of  life,  death  and  disease,  but  he  disagreed  with  Emped- 
ocles in  regard  to  the  manner  in  which  the  four  elements 
are  united,  his  own  belief  being  that  they  form  together 
a  genuine  mixture,  whereas  Empedocles  maintains  that 
their  union  represents  merely  a  mechanical  aggregation 
of  separate  atoms.  He  also  held  that  these  original  four 
elements,  to  which  he  gave  the  names  of  heat,  cold,  dryness 
and  moisture,  were  represented  in  the  human  body  by  the 
following  four  cardinal  fluids  or  '^ juices":  blood,  mucus 
or  phlegm,  black  bile  and  yellow  bile.^  He  maintained, 
further,  that  when  these  elements  are  mingled  harmo- 
niously so  as  to  produce  a  state  of  perfect  equilibrium, 
health  resulted;  but  that  when  some  deficiency  of  one  or 
more  of  them,  or  some  lack  of  harmony  between  them  in 
other  respects,  occurs,  disease  is  produced.  At  a  later  date, 
a  fifth  element — wind  or  air  (pneuma) — ^was  added  to 
the  other  four;  and  when  Hippocrates  was  unable  to 
account  satisfactorily  for  certain  phenomena  of  disease, 
he  was  wont  to  refer  the  phenomenon  observed  to  divine 
interference. 

This  brief  exposition  of  the  physiological  and  patho- 
logical views  held  by  Hippocrates,  incomplete  and  super- 
ficial as  it  is,  mil  have  to  suffice.  Those  who  wish  to 
acquire  a  more  profound  knowledge  of  the  subject  should 
consult  some  of  the  larger  treatises  like  those  of  Darem- 

2  Black  bile,  it  was  believed,  comes  from  the  spleen,  while  the  yellow  variety 
is  a  product  of  the  liver. 


HIPPOCRATES  THE  GREAT  67 

berg,  of  Max  Neuburger,  and  of  Pagel,  as  well  as  the 
sections  devoted  to  these  subjects  in  the  French  (Littre) 
and  the  German  (Fuchs)  versions  of  the  Hippocratic 
writings.  At  every  step  in  such  a  study,  the  modern 
physician  will  encounter  ideas  and  individual  terms  which 
he  will  have  great  difficulty  in  comprehending;  and  later 
on,  as  he  reads  the  sections  which  deal  with  the  more 
practical  matters  of  the  medical  art,  he  will  be  astonished 
to  find  that  Hippocrates  was  a  most  acute  and  trustworthy 
observer  of  the  phenomena  of  disease,  a  remarkably  clear 
writer,  and  a  standard-bearer  of  very  high  aims. 

In  the  examination  and  treatment  of  the  sick  the  physi- 
cians of  ancient  Greece  were  highly  trained.  They  paid 
very  close  attention  to  the  patient's  account  of  his 
symptoms,  but  it  was  to  the  physical  examination  of  the 
diseased  body  that  they  attached  the  greatest  importance. 
They  noted  with  extreme  care  the  color  and  other  peculiari- 
ties of  the  skin  and  mucous  membranes,  the  condition  of 
the  abdomen,  and  the  shape  and  movements  of  the  thorax ; 
they  tested  the  patient's  temperature  by  placing  the  hand 
upon  the  body ;  and  all  the  excretions  were  subjected  to  the 
closest  scrutiny.  By  means  of  palpation  they  were  able 
to  determine  not  only  the  size  of  the  liver  and  spleen,  but 
also  the  changes  which  occur  in  the  form  of  these  organs 
in  the  course  of  certain  diseases.  They  utilized  succussion 
both  as  an  aid  to  diagnosis  and  as  a  means  of  favoring  the 
breaking  through  of  pus  into  the  bronchial  tubes.  They 
were  familiar  with  the  pleuritic  friction  sound  and  with  the 
finest  rales,  which  they  compared  to  the  •  creaking  of 
leather  or  ''the  noise  of  boiling  vinegar."  In  their 
descriptions  of  these  sounds  it  is  distinctly  stated  that 
the  examiner's  cartas  kept  tightly  pressed  against  the 
patient's  chest.         ^ 

In  speaking  of  the  accounts  of  individual  diseases  which 
appear  in  the  Hippocratic  writings,  Puschmann  says  that 
they  are  evidently  based  6n  cases  actually  observed  in 
practice,  and  that  they  are  admirably  written.  It  is  in  the 
laws  which  they  have  laid  down  with  regard  to  the  treat- 
ment of  disease,  however,  that  the  Hippocratic  writers  have 


88  GROWTH  OF  MEDICINE 

gained  their  chief   distinction,   a  distinction  which   will 
belong  to  them  through  all  time. 

The  physician  should  be  the  handy  man  of  Nature,  and  he  should 
strive  to  aid  and  to  imitate  her  efforts  to  effect  a  cure.  His  first 
care  should  be  to  remove,  so  far  as  is  possible,  the  causes  of  the 
disease ;  and  then,  in  the  conduct  of  the  treatment,  he  should  keep 
in  view  at  all  times  the  special  circumstances  of  the  case,  giving 
closer  attention  to  the  patient  than  to  the  disease  itself.  In  short, 
he  should  aim  at  being  useful,  or  at  least  he  should  be  careful  not 
to  do  any  harm. 


1^ 


CHAPTER  VIII 

BRIEF  EXTRACTS  FROM  SOME  OF  THE 
HIPPOCRATIC  WRITINGS 

The  statements  which  have  thus  far  been  made  in  these 
pages  with  regard  to  Hippocrates  are  only  of  a  general 
character,  and  it  may  therefore  be  interesting  for  the 
reader  to  have  placed  before  him  a  few  selected  extracts 
from  the  writings  which  have  formed  the  basis  of  these 
statements.  The  English  text  here  used  is  a  translation 
of  the  German  version  of  Robert  Fuchs,  to  which  reference 
has  already  been  made.  It  would  have  been  a  pleasure  to 
use  for  this  purpose  the  admirable  English  translation  of 
Frederick  Adams,  published  in  1849  under  the  auspices 
of  the  Sydenham  Society  of  Great  Britain;  but,  unfortu- 
nately, this  version  contains  only  a  part  of  the  Hippocratic 
writings,  and,  besides,  this  writer  did  not  at  that  time 
have  the  advantage  of  consulting  the  French  and  German 
versions  which  have  been  published  since  1849. 

It  seems  almost  unnecessary  to  state  here,  by  way  of 
preface,  that  the  small  amount  of  space  which  may  properly 
be  devoted  to  these  extracts  renders  it  necessary  to  present 
many  of  them  in  a  very  fragmentary  and  disconnected 
form,  merely  enough  text  being  furnished  to  give  the 
reader  some  slight  idea  both  of  the  manner  in  which 
Hippocrates  and  those  associated  with  him  handled  certain 
medical  topics,  and  also  of  the  views  which  they  entertained 
with  regard  to  the  same  subjects. 

BRIEF  EXTRACTS  FROM  SOME  OF  THE  HIPPOCRATIC  WRITINGS 

Aphorisms. — I. — 1.  Life  is  short,  art  is  long,  the  right  moment 
lasts  but  an  instant,^  experience  is  often  deceptive,  a  correct 
judgment  is  hard  to  reach. 

1  Daremberg    (Hist,  de  la  Mid.)    makes  the  following  comments   on  this 


90  GROWTH  OF  MEDICINE 

6.     For    the    most   serious    ills    extreme    measures    cautiously- 
employed  are  the  best. 

8.  When  an  illness  has  reached  its  acme  the  lightest  diet  must 
be  prescribed. 

11.  During  the  exacerbations  nourishment  should  be  withheld, 
for  at  these  times  the  giving  of  food  is  harmful;  and  in  illnesses 
which  are  characterized  by  periodic  paroxysms  it  is  also  best  not 
to  give  food  during  the  paroxysms. 

13.  Old  people  bear  fasting  very  well,  and  the  same  is  almost 
true  of  persons  of  mature  age ;  but  young  individuals  do  not  bear 
abstinence  from  food  so  well,  and  this  is  particularly  the  case  with 
children,  especially  with  those  of  a  lively  disposition. 

24.  In  acute  illnesses  laxative  remedies  should  rarelv  be  admin- 
istered, and  then  only  in  the  early  stage  of  the  malady  and  with 
great  caution. 

II. — 2.     When  sleep  puts  an  end  to  delirium  it  is  a  good  sign. 
3.     When   either  sleep   or  wakefulness  oversteps  the   proper 
limit  it  is  harmful. 

5.     Causeless  depression  is  an  indication  of  some  disorder. 

19.  In  acute  diseases  the  prognosis  as  regards  either  death  or 
recovery,  is  very  uncertain. 

44.  Corpulent  persons  are  more  likely  than  those  who  are 
slender  to  die  a  quick  death. 

V. — 7.  When  epileptic  attacks  occur  before  the  age  of  puberty, 
a  change  for  the  better  may  be  looked  for ;  but  if  the  disease  makes 
its  first  appearance  when  the  individual  has  already  reached  his 
twenty-fifth  year,  he  may  be  expected  to  carry  the  affliction  with 
him  to  the  time  of  his  death. 

9.  Consumption    most    commonly    attacks    persons    who    are 
between  the  ages  of  eighteen  and  thirty-five. 

14.  When  a  consumptive  person  has  attacks  of  diarrhoea,  a 
fatal  issue  may  be  anticipated. 

VII. — 1.  If  in  the  course  of  an  acute  illness  the  extremities 
grow  cold,  it  is  an  unfavorable  sign. 

sentence:  "How  many  are  the  occasions  when  we  physicians  would  have  it 
in  our  power  to  avert  death,  or  at  least  to  postpone  it  for  a  few  hours,  if  we 
would  only  engrave  upon  our  memories  these  words  of  the  old  man  of  Cos  I 
'What  a  cruel  responsibility  rests  upon  those  whose  duty  it  is  to  summon  the 
doctor  at  the  proper  moment!  And  how  great  must  be  the  remorse  if  he  fails 
to  arrive  in  time ! '  On  the  other  hand,  how  wise  is  the  remark  of  Celsus : 
'The  best  practitioner  is  he  who  never  loses  sight  of  his  patients.'  " 


EXTRACTS  FROM  HIPPOCRATIC  WRITINGS  91 

14.  If,  after  a  blow  upon  the  head,  stupefaction  or  delirium 
manifests  itself,  the  outlook  is  bad. 

[The  total  number  of  the  aphorisms  is  422.] 

The  Book  of  Prognoses. — 1.  I  believe  that  it  is  best  for  a 
physician  to  acquire  a  certain  degree  of  practice  in  the  power  to 
predict  how  the  disease  is  likely  to  terminate ;  for  if,  when  he  is  in 
-the  presence  of  his  patient,  he  is  able  to  state,  not  only  what  is 
going  to  take  place  in  the  future  course  of  the  malady,  but  also 
certain  other  facts  which  relate  to  the  past  behavior  of  the  attack, 
but  which  were  omitted  from  the  account  given  to  him  of  the 
previous  history  of  the  case,  he  will  impress  the  patient  with  the 
belief  that  he  is  thoroughly  familiar  with  the  disease  from  which 
the  latter  is  suffering,  and  that  consequently  he  is  a  physician 
in  whose  knowledge  and  skill  he  can  place  entire  confidence.  Then, 
besides,  he  will  be  the  gainer  in  another  respect:  his  knowledge 
of  what  is  likely  to  be  the  subsequent  course  of  any  given  disease 
will  enable  him  to  treat  it  in  the  most  effective  manner.  The 
ability  to  restore  all  his  patients  to  health  would  of  course  be  a 
greater  power  than  that  of  correctly  predicting  the  future  behavior 
of  a  malady  in  any  particular  case.  This  ability,  however,  is  clearly 
unattainable.  One  patient  dies  by  reason  of  the  severity  of  the 
disease  itself,  even  before  the  physician  is  called  in;  a  second  one, 
shortly  after  the  latter 's  visit;  and  a  third  lingers  on  for  a  day 
or  two  after  the  doctor's  arrival,  dying  before  the  latter 's  art  has 
had  time  to  produce  a  beneficial  effect  in  hindering  the  advance 
of  the  malady.  The  observation  of  these  different  events  should 
enable  the  physician  to  become  acquainted  with  the  nature  of  the 
diseases  observed,  and — more  particularly — to  learn  to  what  extent, 
in  individual  instances,  they  manifest  a  strength  greater  than  the 
patient's  power  of  resistance.  At  the  same  time,  he  must  not 
forget  that  in  many  cases  divine  interference  plays  a  part  in 
directing  the  course  of  the  disease.  And  thus,  if  he  pays  heed  to 
all  these  things,  the  physician  will  merit  the  confidence  of  his 
patients  and  will  gain  the  reputation  of  being  a  clever  and  skilful 
practitioner. 

IV. — It  is  better  when  the  physician,  upon  the  occasion  of  his 
first  visit,  finds  the  patient  lying  upon  one  side,  with  his  hands, 
neck  and  thighs  slightly  flexed,  and  the  entire  body  placed  in  a 
perfectly  natural  position,  like  that  which  a  man  assumes  in  bed 
when  he  is  in  a  state  of  health.  It  is  not  so  well  when  the  physician 
finds  the  patient  lying  upon  his  back,  with  his  hands,  neck  and 


92  GROWTH  OF  MEDICINE 

thighs  extended.  But  if  the  latter  is  found  curled  up  and  sliding 
down  toward  the  foot  of  the  bed,  this  is  an  unfavorable  sign. 
Finally,  if  he  is  found  with  rather  cold  feet  projecting  from  under 
the  bedclothes,  and  with  his  arms  outstretched  and  his  neck  and 
thighs  exposed,  his  condition  may  be  considered  dangerous,  for 
this  attitude  of  the  body  betokens  an  agitated  state  of  the  mind. 
If  the  patient  sleeps  with  his  mouth  constantly  open,  lying  upon 
his  back  and  with  his  thighs  strongly  flexed  and  widely  separated, 
it  may  be  assumed  that  death  is  near  at  hand.  If  he  lies  upon 
his  belly  when  it  is  known  that  he  was  not  in  the  habit  of  sleeping 
in  this  manner  before  he  was  taken  ill,  the  inference  is  warranted 
either  that  he  is  delirious  or  that  he  is  suffering  from  pain  in  the 
lower  part  of  his  abdomen.  Finally,  if  the  patient  shows  an 
inclination  to  maintain  a  sitting  posture  while  the  malady  is  still 
in  an  active  stage,  this  feature  must  be  looked  upon  as  a  grave 
symptom  and  especially  so  in  inflammation  of  the  lungs. 

XIV. — Pus  that  has  a  whitish  color  and  a  uniform  consistency, 
that  is  smooth  and  free  from  clumps,  and  the  odor  of  which  is  only 
slightly  unpleasant,  is  the  least  harmful.  On  the  other  hand,  a 
pus  which  possesses  the  opposite  characteristics  is  very  dangerous. 

XL. — Severe  pain  in  the  ear,  if  associated  with  a  persistent 
fever  is  dangerous,  for  the  patient  may  become  delirious  and  die. 

[There  are  47  chapters  in  the  Book  of  Prognoses;  in 
addition,  there  are  740  separate  sections  in  the  Coan 
Prognoses  {Praenotiones  Coacae).] 

The  Epidemic  Diseases. — ^VI. — 4.  The  wife  of  Agasis  had 
already  as  a  young  girl  been  troubled  with  shortness  of  breath. 
After  she  had  reached  womanhood,  and  soon  after  she  had  given 
birth  to  a  child,  she  lifted  a  heavy  weight.  Immediately  she  heard, 
as  she  believed,  a  noise  in  her  chest,  and  on  the  following  day  she 
experienced  some  difficulty  in  breathing  and  a  certain  amount  of 
pain  in  her  right  hip.  These  two  symptoms  were  so  related  to 
each  other  that,  whenever  the  pain  in  the  hip  made  its  appearance, 
she  immediately  became  conscious  that  she  was  short  of  breath, 
and,  vice  versa,  whenever  the  pain  ceased,  she  found  that  her 
breathing  became  easier.  Her  expectoration  was  of  a  foamy 
character  and  of  a  rather  bright  color,  but,  after  it  had  been 
allowed  to  stand  for  a  short  time,  it  looked  like  diluted  biliary 
matter  that  had  been  vomited.  The  pain  in  the  hip  troubled  her 
chiefly  when  she  performed  manual  work.     She  was  advised  to 


EXTRACTS  FROM  HIPPOCRATIC  WRITINGS  93 

abstain  from  eating  garlic,  pork,  mutton,  and  beef,  and  not  to 
call  loudly  or  to  get  excited  while  she  was  engaged  in  work. 

VII. — 7.  The  wife  of  Polycrates  became  feverish  during  the 
summer  season,  and  about  the  time  of  the  dog  star.  In  the  morning 
her  breathing  was  somewhat  embarrassed,  but  after  mid-day  it 
became  more  difficult  and  at  the  same  time  more  rapid.  From 
the  very  beginning  of  the  illness  she  had  a  cough  and  expectorated 
purulent  masses.  In  the  throat  and  along  the  course  of  the  trachea 
one  could  hear  a  hoarse  whistling  sound.  The  patient's  face  had 
a  healthy  color,  and  over  the  two  halves  of  the  jaw  there  was  some 
redness,  not  of  a  deep  hue  but  rather  fresh  and  bright.  A  little 
later  her  voice  also  became  hoarse,  she  began  to  show  some 
emaciation,  raw  spots  developed  over  the  fleshy  parts  of  her  hips, 
and  the  surface  of  the  body  grew  more  moist  than  it  had  been 
before.  On  the  seventieth  day  the  outward  evidences  of  fever 
became  much  less  noticeable,  but  the  respiration  grew  more  rapid ; 
and  from  that  day  to  the  time  of  her  death,  five  or  six  days  later, 
she  was  obliged  to  remain  in  a  sitting  posture.  Toward  the  end 
the  tracheal  rale  grew  louder,  and  dangerous  sweats  occurred,  but 
the  patient  never  lost  her  expression  of  intelligence. 

Fractures. — II. — 9.  In  the  human  body  the  foot,  like  the  hand, 
is  composed  of  a  number  of  small  bones.  As  they  are  not  easily 
broken  it  may  safely  be  assumed,  when  such  a  case  of  fracture 
comes  under  observation,  that  some  pointed  or  unusually  heavy 
object  had  caused  the  lesion,  and  that  the  surrounding  soft  parts 
must  necessarily  have  been  injured  at  the  same  time.  (Injuries 
of  this  nature  will  be  discussed  in  a  later  section.)  But  if  any 
part  of  this  bony  framework  is  pushed  out  of  its  natural  position — 
whether  this  take  place  in  one  of  the  toes,  or  in  one  of  the  tarsal 
bones,  it  makes  no  difference — the  dislocated  part  should  be  forced 
back  into  position  in  the  manner  recommended  in  section  XXIV. 
In  its  essential  features  the  treatment  consists  in  the  employment 
of  wax  plaster,  compresses,  and  bandages,  exactly  the  same  as  is 
done  in  the  treatment  of  fractures  of  the  long  bones,  but  without 
splints.  The  same  rules  hold  good  with  regard  to  the  degree  of 
pressure  to  be  applied,  and  every  third  day  the  dressings  should 
be  renewed.  On  each  occasion  of  such  renewal  the  patient  should 
be  questioned  with  regard  to  the  sensations  which  he  feels  after 
the  bandages  have  been  applied,  and  if  necessary  they  should  be 
readjusted  in  accordance  with  the  nature  of  the  answers  which 
he  gives.  The  great  majority  of  these  injuries  heal  completely  in 
twenty  days.    The  exceptional  cases  are  those  in  which  the  fracture 


94  GROWTH  OF  MEDICINE 

involves  a  bone  that  stands  in  immediate  relation  with  the  bones 
of  the  leg.  It  is  advisable,  however,  that  the  patient  should  remain 
in  bed  during  the  period  mentioned;  for,  in  not  a  few  instances, 
the  persons  thus  affected,  failing  to  appreciate  the  gravity  of  the 
injury,  walk  about  before  the  parts  have  really  healed;  and  then, 
for  an  indefinite  period  of  time,  they  are  frequently  reminded  in 
a  painful  manner  of  the  injury  which  they  received.  There  is 
nothing  astonishing  in  this  when  the  fact  is  recalled  to  mind  that 
the  feet  support  the  entire  weight  of  the  body. 

[Forty-eight  chapters  or  sections,  some  of  them  of 
considerable  length,  are  devoted  to  the  subject  of  fractures. 
The  authorities  are  almost  unanimous  in  stating  that  this 
portion  of  the  so-called  Hippocratic  writings  was  written 
by  Hippocrates  himself.  Malgaigne  and  Petrequin,  two  of 
the  most  competent  French  writers  on  questions  relating 
to  surgery,  declare  that  the  treatises  written  by  Hip- 
pocrates on  fractures  and  dislocations  (the  two  forming 
in  reality  one  continuous  treatise)  are  the  best  and  most 
complete  books  ever  written  by  a  physician.] 

Wounds  of  the  Head. — 10.  The  physician  should,  first  of  all, 
before  touching  the  patient's  head,  inspect  carefully  the  wound 
and  surrounding  parts.  After  noting  whether  the  injury  has  been 
inflicted  upon  a  strong  or  a  weak  portion  of  the  head,  he  should 
ascertain  whether  the  hair  has  been  cut  by  the  fall  or  the  blow, 
and  whether  portions  of  it  have  penetrated  into  the  wound.  In 
the  latter  event  he  should  express  his  fear  that  the  skull  at  this 
point  has  been  laid  bare  and  has  perhaps  even  received  some 
material  injury.  He  should  make  this  statement  before  he  has 
touched  or  probed  the  wound.  Then  afterward  he  should  proceed 
to  a  physical  examination  of  the  injured  parts,  in  order  that  he 
may  learn  positively  whether  the  overlying  soft  tissues  have  or 
have  not  been  separated  from  the  bone.  If  simple  inspection 
reveals  the  fact  that  the  skull  has  been  laid  bare,  well  and  good; 
but,  if  the  real  condition  is  not  thus  revealed,  he  should  not  hesitate 
to  employ  the  probe.  If  he  finds  that  the  soft  parts  have  been 
separated  from  the  bone  and  that  the  latter  has  been  more  or  less 
injured,  he  should  continue  this  more  minute  exploration  until 
he  shall  have  ascertained  to  just  what  extent  and  in  what  manner 
the  skull  has  been  injured,  and  what  measures  are  required  to 
remedy  the  damage ;  in  brief,  he  should  make  the  diagnosis.    At  the 


EXTRACTS  FROM  HIPPOCRATIC  WRITINGS  95 

same  time,  however,  he  should  not  neglect  to  question  the  patient 
very  closely  about  the  manner  in  which  the  wound  was  inflicted, 
for  in  this  way  he  may  be  able  to  infer  the  existence  of  a  contusion, 
or  even  a  fracture  of  the  skull,  of  which  no  material  evidences  are 
discoverable.  Important  information  may  also  be  gathered  by 
passing  the  hand  over  the  seat  of  injury  in  the  bone, — information 
which  the  employment  of  the  probe  is  not  competent  to  convey, 

[Twenty-one  additional  chapters  are  devoted  to  wounds 
of  the  head,  every  possible  phase  of  the  subject  being 
handled  by  Hippocrates  in  the  most  careful  and  thorough 
manner.] 


CHAPTER  IX 

THE  STATE  OF  GREEK  MEDICINE  AFTER  THE 
EVENTS  OF  THE  PELOPONNESIAN  WAR;  THE 
FOUNDING  OF  ALEXANDRIA  IN  EGYPT,  AT 
THE  MOUTH  OF  THE  NILE ;  AND  THE  DEVELOP- 
MENT OF  DIFFERENT  SECTS  IN  MEDICINE 

Up  to  the  time  when  war  broke  out  between  Sparta  and 
Athens  (431  B.  C),  the  latter  city  had  for  many  years 
easily  held  the  supremacy,  not  merely  in  everything 
relating  to  the  science  and  art  of  medicine,  but  also  in  all 
other  branches  of  learning  and  especially  in  the  arts  of 
sculpture,  painting  and  architecture.  At  the  time  named 
above  came  the  beginning  of  her  downfall.  For  a  period 
of  about  twenty-one  years  she  struggled  against  disasters 
of  all  sorts. 

The  Plague  at  Athens,  the  first  Recorded  in  History. — 
Shortly  after  the  war  began — a  war  engendered  by  the 
bitter  jealousy  of  Sparta  over  the  ever  increasing  ascend- 
ancy of  her  rival — the  latter  city  was  visited  by  a  devas- 
tating plague,  the  first  European  pestilence  that  has  been 
recorded  in  history.  Thucydides,  who  wrote  the  history 
of  the  Peloponnesian  War,  gives  a  most  lucid  description 
of  this  plague  of  Athens,  from  which  I  shall  copy  certain 
portions. 

It  first  began,  it  is  said,  in  the  parts  of  Ethiopia  above  Egypt, 
and  thence  descended  into  Egypt  and  Libya  and  into  most  of  the 
King's  country.  Suddenly  falling  upon  Athens,  it  first  attacked 
the  population  in  Piraeus, — which  was  the  occasion  of  their  saying 
that  the  Peloponnesians  had  poisoned  the  reservoirs,  there  being 
as  yet  no  wells  there, — and  afterward  appeared  in  the  upper 
city,  when  the  deaths  became  much  more  frequent.    All  speculation 


DEVELOPMENT  OF  SECTS  IN  MEDICINE     97 

as  to  its  origin  and  its  causes,  if  causes  can  be  found  adequate  to 
produce  so  great  a  disturbance,  I  leave  to  other  writers,  whether 
lay  or  professional ;  for  myself,  I  shall  simply  set  down  its  nature, 
and  explain  the  symptoms  by  which  perhaps  it  may  be  recognized 
by  the  student,  if  it  should  ever  break  out  again.  This  I  can  the 
better  do,  as  I  had  the  disease  myself,  and  watched  its  operation 

in  the  case  of  others People  in  good  health  were  all  of  a 

sudden  attacked  by  violent  heats  in  the  head  and  redness  and 
inflammation  in  the  eyes,  the  inward  parts,  such  as  the  throat  or 
tongue,  becoming  bloody  and  emitting  an  unnatural  and  fetid 
breath.  These  symptoms  were  followed  by  sneezing  and  hoarse- 
ness, after  which  the  pain  soon  reached  the  chest,  and  produced 
a  hard  cough.  When  it  fixed  in  the  stomach,  it  upset  it;  and 
discharges  of  bile  of  every  kind  named  by  physicians  ensued, 
accompanied  by  very  great  distress.  In  most  cases,  also,  an 
ineffectual  retching  followed,  producing  violent  spasms,  which  in 
some  cases  ceased  soon  after,  in  others  much  later.  Externally 
the  body  was  not  very  hot  to  the  touch,  nor  pale  in  its  appearance, 
but  reddish,  livid,  and  breaking  out  into  small  pustules  and  ulcers. 
But  internally  it  burned  so  that  the  patient  could  not  bear  to  have 
on  him  clothing  or  linen  even  of  the  very  lightest  description; 
or  indeed  to  be  otherwise  than  stark  naked.  What  they  would 
have  liked  best  would  have  been  to  throw  themselves  into  cold 
water;  as  indeed  was  done  by  some  of  the  neglected  sick,  who 
plunged  into  the  rain-tanks  in  their  agonies  of  unquenchable 
thirst;  though  it  made  no  difference  whether  they  drank  little  or 
much.  Besides  this,  the  miserable  feeling  of  not  being  able  to  rest 
or  sleep  never  ceased  to  torment  them.  The  body  meanwhile  did 
not  waste  away  so  long  as  the  distemper  was  at  its  height,  but  held 
out  to  a  marvel  against  its  ravages;  so  that  when  they  succumbed, 
as  in  most  cases,  on  the  seventh  or  eighth  day  to  the  internal 
inflammation,  they  had  still  some  strength  in  them.  But  if  they 
passed  this  stage,  and  the  disease  descended  further  into  the 
bowels,  inducing  a  violent  ulceration  there  accompanied  by  severe 
diarrhoea,  this  brought  on  a  weakness  which  was  generally  fatal. 
For  the  disorder  first  settled  in  the  head,  ran  its  course  from 
thence  through  the  whole  of  the  body,  and,  even  where  it  did  not 

prove  mortal,  it  still  left  its  mark  on  the  extremities; 

some,  too,  escaped  with  the  loss  of  their  eyes Some  died 

in  neglect,  others  in  the  midst  of  every  attention.  No  remedy  was 
found  that  could  be  used  as  a  specific;  for  what  did  good  in  one 
case,  did  harm  in  another Such  was  the  nature  of  the 


98  GROWTH  OF  MEDICINE 

calamity,  and  heavily  did  it  weigh  on  the  Athenians ;  death  raging 
within  the  city  and  devastation  without. 

(Translation  of  Richard  Crawley;  Dent  &  Sons,  London.) 

Athens  Ceases  to  be  the  Centre  of  Medical  Learning. — 
It  is  safe  to  assume  that  one  by  one  the  more  prominent 
of  the  physicians  who  had  survived  the  events  which  have 
just  been  narrated,  must  have  left  Athens  and  taken  up 
their  abode  in  the  various  cities  of  Asia  Minor  and  the 
neighboring  islands,  in  Sicily,  in  Italy,  etc.  Hippocrates, 
who  was  thirty  years  old  at  the  time  when  the  plague  broke 
out  in  Athens,  appears  not  to  have  witnessed  it.  He 
practiced  his  profession  and  taught  medicine  in  his  native 
city;  then  he  spent  a  certain  number  of  years  in  traveling 
about  as  a  peripatetic  physician;  and  finally  settled  for 
the  remainder  of  his  life  in  Thessaly.  But  the  length  of 
each  of  these  periods  of  his  professional  life  is  not  men- 
tioned by  any  of  the  authorities.  About  forty  years  after 
the  death  of  Hippocrates,  Alexander  the  Great  had  already 
nearly  completed  his  series  of  brilliant  conquests,  and  was 
taking  steps  to  found  a  city,  or  rather,  a  university,  in 
which  medicine  was  to  take  an  organized  shape  as  one  of 
the  great  departments  of  human  learning. 

It  may  be  well  at  this  point,  however,  to  interrupt  this 
narrative  of  the  regular  course  of  events  for  the  purpose 
of  considering  very  briefly  how  far  the  physicians  of  that 
period  had  advanced  toward  gaining  a  permanent  and 
honorable  position  in  their  respective  communities. 

The  Degree  of  Esteem  in  which  Physicians  Were  Held  by 
Their  Fellow  Citizens  and  by  the  Governing  Authorities 
During  the  Centuries  Immediately  Preceding  the  Christian 
Era, — ^We  have  at  our  command  very  little  direct  evidence 
bearing  upon  the  question  of  the  esteem  in  which  physicians 
were  held  three  hundred  years  B.  C.  by  the  communities 
in  which  they  practiced  their  profession.  We  know  posi- 
tively that  the  kings  and  princes  of  that  period  fully 
appreciated  the  value  of  the  services  which  were  rendered 
to  them  by  the  physicians  (commonly  Greeks)  whom  they 
employed.  In  the  event  of  war  they  took  with  them  men 
who  were  skilled  both  in  surgery  and  in  the  treatment  of 


DEVELOPMENT  OF  SECTS  IN  MEDICINE     99 

the  ordinary  ills  of  the  body.  One  of  the  sons  of  Hip- 
pocrates, for  example,  served  for  some  time  in  this 
capacity,  and  he  is  credited  with  the  statement  that  *'the 
physician  who  wishes  to  obtain  the  best  training  in 
surgery  should  enter  the  service  of  the  army."  There 
were  eight  surgeons  officially  connected  with  the  **ten 
thousand"  whom  Xenophon  led  back  to  Greece  after  the 
famous  campaign  in  Asia  Minor.  The  army  of  Alexander 
the  Great  was  accompanied  by  the  most  celebrated  surgeons 
of  that  period.  Upon  a  bronze  tablet  found  at  Idalium, 
on  the  Island  of  Cyprus,  there  is  an  inscription  which  dates 
back  to  the  fifth  century  B.  C,  and  which  commemorates 
the  merits  of  a  physician  named  Onasilos,  who,  aided  by 
his  pupils,  rendered  valuable  services,  without  any  remu- 
neration, during  one  of  the  wars  of  the  Greeks;  and  in 
recognition  of  these  services,  the  Government  had  bestowed 
upon  him  a  stipend  and  had  exempted  him  from  taxation. 
It  is  further  known  that  the  Athenians  lavishly  heaped 
honors  upon  Hippocrates,  initiating  him  at  public  expense 
into  the  mysteries  of  the  Eleusinia,  giving  him  a  crown  of 
gold,  and  distinguishing  him  in  still  other  ways.  These 
facts  show  how  highly  the  rulers  of  that  day  appreciated 
the  services  of  a  competent  physician;  but,  up  to  a  com- 
paratively recent  date,  it  has  not  been  so  easy  to  demon- 
strate what  was  his  position  in  the  esteem  of  the  community 
at  large.  The  discovery,  not  many  years  ago,  of  two 
inscriptions  in  Greek  throw  a  certain  amount  of  light  upon 
this  very  point.  One  of  these,  which  bears  the  date  of 
388  B.  C.,  states  that  its  purpose  is  to  commemorate  the 
fact  that  the  physician  Euenor,  who  had  been  intrusted 
by  the  people  with  the  work  of  supervising  the  preparation 
of  all  the  drugs  intended  for  use  in  the  public  hospital, 
had  not  only  fulfilled  his  duty  but  had  in  addition  spent 
large  sums  of  his  own  money  in  the  accomplishment  of 
this  work.  Another  inscription,  which  was  unearthed  in 
the  Island  of  Carpathus,  between  Crete  and  Rhodes,  and 
which  is  believed  to  date  back  to  the  end  of  the  fourth  or 
the  beginning  of  the  third  century  B.  C,  reads  (in  a  some- 
what abbreviated  form)  as  follows:    **In  view  of  the  fact 


100  GROWTH  OF  MEDICINE 

that,  for  more  than  twenty  years,  Menocritus,  the  son  of 
Metrodorus  of  Samos,  has  devoted  himself  with  much  zeal 
and  self-sacrifice  to  the  duties  of  his  position  as  parish 
physician,  living  all  this  time  in  rather  narrow  circum- 
stances and  not  asking  any  pay  for  his  services,  we,  the 
citizens  of  Brycontium,  have  resolved  to  erect  in  his  honor, 
in  the  temple  of  Neptune,  a  marble  column  bearing  an 
inscription  that  shall  set  forth  these  facts,  to  crown  him 
with  a  wreath  of  gold,  and  to  announce  publicly,  at  the 
Aesculapian  games,  this  our  decision."  As  apropos  of 
this  subject  I  may  be  permitted  to  quote  the  following 
words  from  Plato's  **The  Republic"  (Book  1,  Chap.  18) : 
''Will  you  call  the  medicinal  the  mercenary  art,  if,  in 
performing  a  cure,  one  earns  a  reward?    No,  said  he." 

The  Founding  of  Alexandria. — ^Alexander  the  Great, 
after  subduing  the  Persians  and  the  cities  of  Phoenicia, 
marched  into  Egypt  and  founded  (331  B.  C),  at  the  mouth 
of  the  Nile,  the  city  of  Alexandria,  In  October  of  the  same 
year  he  crossed  the  Euphrates  and  the  Tigris  and  defeated, 
for  the  second  time,  the  Persian  hosts  under  Darius. 
Alexander  was  now  the  conqueror  of  Asia.  During  the 
following  eight  years  he  laid  his  plans  most  carefully  for 
the  consolidation  of  his  great  empire,  the  capital  of  which 
was  to  have  been  Babylon;  but,  while  he  was  thus  making 
provision  for  the  welfare  of  his  numerous  subjects,  who 
were  of  widely  different  tastes  and  aspirations,  he  suc- 
cumbed (323  B.  C.)  to  a  severe  attack  of  malarial  fever, 
aggravated  by  an  excessive  indulgence  in  wine  on  the 
occasion  of  some  festivity.  In  the  meantime  Alexandria 
was  developing  rapidly  into  a  great  centre  of  learning  in 
all  the  departments  of  human  knowledge.  The  Ptolemies, 
beginning  with  Ptolemy  Soter,  who  reigned  over  Egypt 
from  323  to  285  B.  C,  contributed  greatly  to  this  result. 
For  a  period  of  about  250  years  Alexandria  remained  the 
centre  around  which  revolved  all  that  was  best  in  the 
domains  of  medicine,  philosophy,  geometry,  mathematics, 
history,  etc.  Money  was  spent  lavishly  in  collecting  the 
writings  of  all  those  authors  who  had  distinguished  them- 
selves in  these  different  fields  of  learning,  and  no  pains 


BEVELOPMENT  OF  SECTS  IN  MEDICINE    101 

were  spared  to  secure  correct  versions  of  the  different 
works;  the  septuagint  version  of  the  books  of  the  Old 
Testament  of  the  Bible  being  a  conspicuous  example  of 
what  the  Ptolemies  accomplished  in  this  direction  during 
the  third  century  B.  C.  Every  possible  facility  was  offered 
at  the  same  time  for  the  giving  and  receiving  of  instruction ; 
and  thus,  with  the  immense  library  as  a  foundation  of 
priceless  value,  the  Museum  at  Alexandria  became  in  every 
material  respect  a  great  university,  the  first  one  of  which 
history  gives  us  any  fairly  satisfactory  information. 
Several  years  after  the  Museum  library  was  established 
a  second  one  of  somewhat  smaller  proportions  was 
organized  in  the  Serapeum  (Temple  of  Serapis).  The 
example  set  by  the  Ptolemies  was  followed  by  Attains, 
King  of  Pergamum  in  Mysia,  Asia  Minor  (241  B.  C),  and, 
before  many  years  had  elapsed,  the  great  library  of  that 
city  almost  rivaled  those  of  the  Museum  and  Serapeum 
at  Alexandria.  It  was  the  competition  between  these  two 
royal  collectors  of  books  that  led  to  the  issuing  of  a  decree 
that  no  more  papyrus  was  to  be  exported  from  Egypt,  and 
thus  there  was  provided  the  stimulus  which  led  to  the 
discovery  or  invention  of  a  new  and  better  material  on 
which  books  might  be  written — viz.,  Pergamentum  (our 
parchment),  a  word  coined  from  the  name  of  the  city  in 
which  it  was  invented. 

The  Development  of  Different  Sects  or  Schools  of 
Medicine. — Up  to  the  time  of  the  death  of  Hippocrates 
medicine  maintained  the  character  of  a  single  organized 
and  harmonious  body;  but,  when  this  great  physician  had 
disappeared  from  the  scene  and  was  no  longer  there  to 
guide  the  further  development  of  medical  science  and  to 
keep  his  followers  working  shoulder  to  shoulder  with  a 
single  spirit  and  purpose,  this  hitherto  homogeneous  body 
split  up  into  sects  or  schools,  each  of  which  had  some 
favorite  doctrine  the  promulgation  of  which  seemed  to 
each  group  of  adherents  to  be  of  great  importance.  There 
were  at  first  two  such  principal  groups,  viz.,  the  Dogmatics 
and  the  Empirics.  The  former  was  composed  of  those  who 
laid  great  stress  upon  speculation  or  theorizing, — that  is, 


102  GROWTH  OF  MEDICINE 

upon  the  use  of  the  reasoning  power, — and  the  latter  of 
men  who  maintained  that  actual  experience  was  the  only- 
thing  of  any  serious  value.  The  respective  leaders  of 
these  two  groups  or  sects  were  Plato  and  Aristotle. 

In  Raphael's  celebrated  painting,  ''The  School  of 
Athens,"  these  two  heroes  of  philosophy  are  represented 
standing  side  by  side — Plato  with  his  right  hand  elevated 
and  pointing  toward  heaven,  while  Aristotle  is  looking 
distinctly  at  the  earth.  Pictorially,  the  tendencies  of  the 
two  schools  of  philosophy  could  not  have  been  better 
represented.  Plato's  genius  had  taken  its  flight  heaven- 
ward and  was  contemplating  earthly  things  from  this  point 
of  vantage ;  his  method  being  to  ignore  system  and  to  look 
at  everything  with  the  eyes  of  purest  love.  ''Delightfully 
poetic,  but  thoroughly  unprofitable  speculation  as  to 
what  constitutes  scientific  truth  and  perfected  morality!" 
(Friedlaender.) 

Aristotle,  whose  father  was  a  physician  and  a  descendant 
of  Aesculapius,  was  the  hero  and  guiding  spirit  of  those 
who  based  their  philosophy  on  experience,  on  ascertained 
facts.  Like  his  celebrated  pupil,  Alexander  the  Great,  who 
brought  whole  nations  under  his  sway,  he  too  was  a 
conqueror  in  every  field  of  human  knowledge.  His  ideas 
ruled  supreme  over  the  minds  of  men  for  thousands  of 
years  and  to-day,  although  many  of  them  are  no  longer 
accepted  as  valid,  Aristotle  himself  is  universally  held  to 
have  been  the  greatest  thinker  and  investigator  who  has 
ever  lived  upon  this  earth.  (In  chapter  XIII,  I  shall  have 
occasion  to  say  something  further  regarding  the  Dogmatics 
and  the  Empirics.) 

Out  of  the  teachings  of  Plato  and  Aristotle  developed 
two  schools  of  philosophy  that  exerted,  in  course  of  time, 
a  great  influence  upon  the  minds  of  men  and  upon  the 
growth  of  medical  science.  The  schools  referred  to  are  the 
Epicureans  and  the  Stoics.  Epicurus  (242-270  B.  C),  who 
gave  his  name  to  the  first  of  these,  taught  that  the  highest 
good  was  happiness. 

The  happiness  he  taught  his  followers  to  seek  was  not  sensual 
enjoyment,  but  peace  of  mind  as  the  result  of  the  cultivation  of 


DEVELOPMENT  OF  SECTS  IN  MEDICINE    103 

all  the  virtues.  According  to  the  teaching  of  his  school  virtue 
should  be  practiced  because  it  leads  to  happiness;  whereas  the 
Stoics  taught  that  virtue  should  be  cultivated  for  her  own  sake, 
irrespective  of  the  happiness  it  will  ensure.  Zeno  (circa  370-260 
B.  C),  the  founder  of  the  Stoic  philosophy,  taught  an  ethical 
system  according  to  which  virtue  consists  in  absolute  judgment, 
absolute  mastery  of  desire,  absolute  control  of  the  soul  over  pain, 
and  absolute  justice.  The  kejmote  of  the  system  is  duty,  as  that 
of  Epicureanism  is  pleasure.     (Sir  "William  Smith.) 

In  addition  to  the  sects  named  above,  there  was  still 
another  known  as  the  Older  Dogmatic  School,  which  was 
composed  of  men  who  had  been  the  direct  followers  of  the 
great  master,  but  who,  forgetting  altogether  the  practical 
teachings  of  Hippocrates  with  regard  to  the  importance 
of  experience,  gave  themselves  up  to  all  sorts  of  hypotheses 
and  theories.  Among  the  names  of  the  earliest  followers 
of  this  school  one  is  astonished  to  find  those  of  Thessalus 
and  Draco,  the  sons  of  Hippocrates,  as  well  as  the  name 
of  Polybus,  the  latter 's  son-in-law.  Diodes  of  Carystos 
and  Praxagoras  of  Cos,  two  of  the  most  distinguished 
men  of  that  period,  were  also  among  the  earliest  members 
of  this  dogmatic  school.  Diodes,  who  was  one  of  the 
Asclepiadae,  owed  his  celebrity  in  part  to  his  contributions 
to  our  knowledge  of  anatomy  and  in  part  to  the  work  which 
he  had  done  in  other  departments  of  medicine.  Unfortu- 
nately, all  of  these  writings  have  been  lost  with  the 
exception  of  a  few  fragments  which  came  to  light  toward 
the  middle  of  the  nineteenth  century.  Praxagoras  was  also 
one  of  the  Asclepiadae.  He  was  distinguished,  as  has 
already  been  stated  on  an  earlier  page,  by  the  fact  that 
he — and  not  Aristotle,  as  is  sometimes  stated — was  first 
to  recognize  the  difference  between  arteries  and  veins,  and 
also  by  the  further  fact  that  he  called  attention  to  the 
practical  value  of  the  pulse  as  an  indication,  in  certain 
diseases,  of  the  tone  of  the  patient's  bodily  condition  or 
vitality. 


CHAPTER  X 

ERASISTRATUS  AND  HEROPHILUS,  THE  TWO 
GREAT  LEADERS  IN  MEDICINE  AT  ALEX- 
ANDRIA; THE  FOUNDING  OF  NEW  SECTS 

Two  of  the  most  celebrated  physicians  of  that  period 
(305-280  B.  C.)  were  Erasistratus  and  Herophilus,  both 
of  whom  were  distinguished  as  the  founders  of  schools  or 
sects  of  medicine  at  Alexandria.  They  had  received  their 
early  training  as  physicians  from  Chrysippus,  a  widely 
known  Stoic  philosopher,  who,  according  to  Albert  von 
Haller,  had  taught  at  the  school  of  Cnidus  and  had  also 
written  on  medical  topics ;  and,  among  the  other  teachers, 
it  is  stated  that  Anaxagoras  of  Cos  had  instructed 
Herophilus,  and  that  Metrodorus,  the  son-in-law  of  Aris- 
totle, had  performed  the  same  service  for  Erasistratus. 
So  far  as  fundamental  principles  are  concerned,  the  schools 
founded  by  these  two  physicians  at  Alexandria  differed 
very  little  from  each  other,  and  the  men  themselves  also 
gained  their  distinction  in  very  much  the  same  branches 
of  medical  knowledge,  both  of  them  having  made  a  number 
of  original  discoveries  in  anatomy  and  both  of  them  having 
become  eminent  practitioners. 

Herophilus  was  born  at  Chalcedon,  a  Greek  city  on  the 
Propontus,  nearly  opposite  to  Byzantium.  We  possess  no 
knowledge  whatever  regarding  the  earlier  years  of  his 
career,  notwithstanding  the  fact  that  no  fewer  than  four 
different  men  devoted  their  energies  to  the  writing  of  his 
biography.  The  books  themselves  have  been  either  lost 
or  destroyed.  Herophilus  showed  a  decided  leaning  toward 
the  study  of  anatomy,  and  his  contributions  to  this  branch 
of  medicine   are   among  the   earliest  which  we   possess. 


ERA8ISTRATUS  AND  HEROPHILUS         105 

I'erophilus  strove  to  supply  one  of  the  most  conspicuous 
;ficiencies  in  the  Hippocratic  system  of  medicine,  viz., 
inadequate  knowledge  of  the  nervous  system;  and  to  this 
end  he  conducted  a  series  of  the  most  careful  investigations, 
as  a  result  of  which  he  was  successful  in  establishing 
several  facts  previously  unknown.  He  described  the  mem- 
branes of  the  brain,  the  choroid  plexus,  the  venous  sinuses, 
the  structure  which  bears  his  name, — the  torcular  Hero- 
phili, — the  cerebral  ventricles,  and  the  calamus  scriptorius ; 
he  traced  the  course  of  the  nerve  trunks  for  some  distance 
from  their  origin  in  the  brain  and  spinal  cord ;  and  it  was 
he  who  established  the  fact  that  two  different  sets  of  nerves 
exist — one  for  conveying  sensations  to  the  brain  and  the 
other  for  producing  motion.  In  addition,  he  investigated 
the  corpus  vitreum,  the  retina,  the  optic  nerve,  etc.  He  also 
called  attention  to  the  peculiar  mode  of  construction  of 
the  duodenum,  and  to  the  fact  that  the  walls  of  the  arteries 
are  thicker  than  those  of  the  veins.  Some  idea  of  the 
accurate  manner  in  which  he  carried  on  his  anatomical 
researches  may  be  gained  from  the  fact  that  he  noted  the 
circumstance  that  the  left  vena  spermatica  occasionally 
originates  in  the  vena  renalis. 

Herophilus  also  gained  distinction  in  the  practical 
branches  of  medicine.  According  to  Puschmann  he  laid 
the  foundations  for  a  scientific  sphygmography.  Thus  he 
distinguished  several  varieties  of  pulse  in  accordance  with 
the  differences  which  he  noted  in  its  strength,  regularity, 
degree  of  fulness,  and  rate  of  speed.  He  also  must  have 
had  considerable  experience  in  surgery,  as  is  shown  by  his 
remark  that  a  dislocation  of  the  thigh,  owing  to  the  tearing 
of  the  ligamentum  teres  which  necessarily  accompanies 
such  a  dislocation,  is  likely  to  occur  again  in  the  same 
individual.  In  his  writings  relating  to  the  practice  of 
medicine,  Herophilus  upheld  the  principle  that  experience 
alone  should  be  our  guide,  as  theoretical  considerations  are 
not  to  be  trusted.  He  is  also  credited  with  having  said,  in 
response  to  the  question.  Whom  do  you  consider  the  best 
physician?  "Him  who  knows  how  to  distinguish  what  is 
attainable  from  what  is  unattainable. ' ' 


106  GROWTH  OF  MEDICINE 

Erasistratus,  the  contemporary  of  HeropMlus  and  his 
associate  in  the  work  of  establishing  at  Alexandria  a  great 
anatomical  and  clinical  medical  school,  was  a  native  of 
Julis,  in  the  Island  of  Ceos,  not  far  from  the  coast  of 
Attica.  In  the  earlier  part  of  his  professional  career  he 
spent  some  time  at  the  Court  of  Seleucus,  the  founder  of 
the  Syrian  monarchy  (312-280  B.  C).  This  monarch,  who 
had  been  one  of  Alexander  the  Great's  distinguished 
generals,  consigned  the  government  of  the  eastern  part 
of  his  vast  kingdom  to  his  son  Antiochus.  The  latter  fell 
ill  about  this  time,  and  the  most  distinguished  physicians 
of  the  Court  were  then  called  in  to  determine  what  was  the 
nature  of  his  malady  and  to  decide  upon  the  proper  treat- 
ment. The  patient  grew  more  and  more  languid,  showed 
complete  indifference  to  all  that  took  place  about  him,  and 
steadily  lost  flesh.  Erasistratus,  who  was  one  of  the 
physicians  summoned,  observed  his  behavior  very  closely 
and  soon  noted  the  fact  that,  whenever  Stratonice,  his 
young  and  attractive  stepmother,  entered  the  sick  room, 
Antiochus  became  agitated ;  his  face  being  flushed,  his  voice 
subdued,  his  pulse  more  rapid,  and  his  eyes  brighter,  all 
of  which  signs  of  excitement  disappeared  when  Stratonice 
left  the  room.  From  these  phenomena  this  shrewd  observer 
drew  the  inference  that  the  patient  was  deeply  but  hope- 
lessly in  love  with  his  father's  second  wife.  Accordingly 
he  informed  Seleucus  that  his  son's  illness  was  simply  the 
result  of  having  lost  his  heart  to  one  who  was  unable  to 
return  his  affection.  Seleucus,  who  was  much  astonished, 
asked  with  deep  interest  who  was  the  lady.  ''My  wife,'* 
replied  Erasistratus,  without  an  instant's  hesitation.  ''But 
tell  me  then,"  asked  Seleucus,  "would  you  be  willing  to 
cause  the  death  of  my  son,  who  is  so  very  dear  to  me,  by 
refusing  to  give  up  your  wife  to  him?"  "Would  you, 
yourself,  my  lord,  under  similar  circumstances,"  replied 
the  physician,  "be  willing  to  give  up  Stratonice  to  the 
Prince,  if  it  had  been  she  with  whom  he  had  fallen  in  love  ? ' ' 
Seleucus  having  already  vowed  that  he  would  not  hesitate 
for  a  moment  to  do  so,  Erasistratus  declared  the  whole 
truth  to  him,  and  of  course  there  was  nothing  left  for  the 


ERASISTRATU8  AND  HEROPHILUS         107 

King  but  to  keep  his  word.  History  fails  to  state  whether 
or  not  the  lady  made  any  objection  to  the  transfer.  As 
Antiochus  lived  to  reign  for  many  years  after  the  murder 
of  his  father,  it  is  safe  to  assume  that  he  recovered  his 
health. 

This  brief  tale,  the  truth  of  which  is  not  disputed  by  any 
of  the  authorities,  reveals  Erasistratus  to  have  been  a 
clever  diagnostician,  to  have  possessed  a  profound  knowl- 
edge of  human  nature,  and  to  have  been  a  man  of  excep- 
tional courage;  in  short,  he  was  a  physician  admirably 
fitted  to  act  as  the  founder  and  leader  of  one  of  the  two 
great  medical  schools  of  Alexandria.  The  following 
account  may  suffice  to  convey  some  idea  of  his  career  after 
he  became  established  at  the  latter  city. 

At  the  beginning  of  his  residence  in  Alexandria, 
Erasistratus,  like  his  great  rival  Herophilus,  devoted  his 
energies  to  anatomical  and  physiological  researches. 
These  two  men  evidently  realized  to  the  full  how  important 
it  was  to  medicine,  if  it  were  to  make  a  substantial  advance 
beyond  the  point  to  which  Hippocrates  and  his  followers 
had  already  carried  it,  that  a  more  complete  understanding 
of  the  structure  and  working  of  the  human  body  should  be 
obtained;  and  their  efforts  in  this  direction  were  greatly 
aided  by  the  enlightened  views  of  the  kings  of  Egypt,  the 
Ptolemies,  who  did  everything  in  their  power  to  furnish 
these  two  investigators  with  all  the  human  dissecting 
material  they  could  use  to  advantage.  They  even  went  so 
far  as  to  allow  them  the  privilege  of  utilizing,  for  scientific 
purposes,  the  living  bodies  of  imprisoned  criminals,  ''in 
order  that  they  might  in  this  way  learn  the  location,  color, 
shape,  size,  construction,  hardness,  softness,  smoothness, 
nature  of  external  surface,  protuberances  and  recesses  of 
the  individual  organs  during  life."  The  defense  which 
they  offered  for  permitting  such  vivisections  was  this: 
"It  is  permissible  to  sacrifice  the  lives  of  a  few  criminals 
if  many  worthy  persons  may  thereby  be  permanently 
benefited  in  health,  or  have  their  lives  prolonged." 
(Puschmann.)  Those  who  were  opposed  to  such  exami- 
nations upon  human  beings  expressed  their  disapproval  in 


108  GROWTH  OF  MEDICINE 

the  following  terms:  **TMs  practice  is  not  only  cruel,  but 
useless,  and  at  the  same  time  it  derogates  from  the  dignity 
of  the  healing  art,  which  is  intended  to  be  a  blessing  and 
not  a  source  of  pain  to  man;  for  those  in  whom  the 
abdominal  cavity  is  first  opened  and  then  the  diaphragm 
divided,  die  before  it  is  possible  to  make  the  scientific 
examination  '  during  life '  which  constitutes,  as  it  is  claimed, 
the  justification  for  the  entire  procedure."  (Puschmann.) 
As  regards  the  work  done  by  Erasistratus  in  the  depart- 
ments of  anatomy  and  physiology,  the  following  statement 
may  be  made:  He  threw  a  great  deal  of  additional  light 
upon  the  structure  of  the  lacteals,  the  valves  of  the  heart, 
the  brain,  the  nerves,  and  several  other  portions  of  the 
body ;  and  he  assigned  to  the  pneuma,  or  breath,^of  which 
he  assumed  that  two  kinds  exist, — the  most  important  role 
in  the  mechanism  of  life.  According  to  the  description 
given  by  Galen  and  reported  by  Le  Clerc,  the  phenomena 
to  which  Erasistratus  refers  take  place  somewhat  as 
follows:  ''When  the  thorax  or  chest  expands,  the  lungs 
also  undergo  dilatation  and  fill  themselves  with  air.  This 
air,  entering  first  by  way  of  the  trachea,  ultimately  reaches 
the  anastomosing  terminals  of  the  bronchial  tubes,  from 
which  locality  the  heart,  by  the  act  of  dilatation,  draws  it 
into  itself,  and  then,  immediately  afterward  contracting, 
sends  it,  by  way  of  the  great  artery  (the  Aorta),  to  every 
part  of  the  body."  When  it  is  considered  that  at  this 
remote  period  of  time  nothing  was  known  about  oxygen 
and  carbon  dioxide,  nor  about  the  power  of  these  elements 
to  pass  freely  through  a  thin  membrane  (exosmosis  and 
endosmosis),  no  surprise  will  be  felt  that  Erasistratus 
carried  the  physiology  of  respiration  no  farther  than  he 
did.  On  the  contrary,  it  is  remarkable  that  he  was  able  to 
describe  so  correctly  this  complicated  process.  In  fact, 
none  of  his  successors,  up  to  the  time  when  Harvey's  great 
discovery  was  announced,  was  able  to  furnish  a  better 
description.  The  physiology  of  gastric  digestion  was 
another  of  the  problems  concerning  which  Erasistratus 
held  views  that  were  different  from  those  commonly 
accepted  by  the  physicians  of  that  time.    The  stomach,  he 


ERASISTRATUS  AND  HEROPHILUS         109 

maintained,  first  retracts  when  portions  of  food  are 
introduced  and  then  contracts  in  such  a  manner  as  to  break 
them  up  into  smaller  and  smaller  fragments ;  this  process 
taking  the  place  of  that  of  *'coction,"  as  taught  by  Hip- 
pocrates. The  resulting  chyle  passes  from  the  stomach 
into  the  liver  and  is  deposited  in  those  spots  where  the 
finer  branches  of  the  vena  cava  and  the  terminal  twigs  of 
the  channels  which  lead  into  the  gall-bladder  come  together. 
Here  the  chyle  breaks  up  into  two  portions,  one  of  which — 
viz.,  that  which  contains  biliary  elements — gains  an 
entrance  into  the  channels  that  lead  to  the  gall-bladder, 
while  the  other,  which  is  composed  of  elements  suitable 
for  making  pure  blood,  finds  its  way  into  the  ramifications 
of  the  vena  cava.  While  holding  these  views  about  the 
mode  of  transformation  of  gastric  chyle  into  the  bile  and 
pure  blood,  Erasistratus  did  not  hesitate  to  confess  that 
he  was  unable  to  say  whether  bile  was  produced  within 
the  body  or  whether  it  already  existed  in  the  food  that  was 
taken  into  the  stomach. 

As  regards  the  treatment  of  disease  Erasistratus  held 
certain  views  which  were  decidedly  at  variance  with  those 
maintained  by  the  majority  of  his  associates.  Thus,  for 
example,  Straton,  a  distinguished  disciple  of  this  master, 
praises  him  for  having  banished  bloodletting  from  the  list 
of  remedial  measures,  and  adds  that  he  can  testify  to  the 
fact  that  Erasistratus  had,  by  other  means,  cured  all  the 
diseases  in  which  the  ancients  commonly  employed  blood- 
letting as  the  chief  remedial  agent.  His  favorite  substitutes 
for  the  latter  procedure  were  fasting,  dieting,  physical 
exercise,  and — in  cases  of  hemorrhage — placing  ligatures 
around  the  arms  and  legs.  Caelius  Aurelianus  is  authority 
for  the  statement  that,  in  certain  very  exceptional  cases, 
Erasistratus  did  resort  to  bloodletting.  Another  of  the 
latter 's  tenets  was  his  strong  objection  to  the  employment 
of  purgatives  and  composite  remedies.  On  the  other  hand, 
he  appears  to  have  attached  considerable  importance  to 
the  employment  of  chicory  in  the  treatment  of  all  disorders 
of  the  abdominal  organs.  One  of  the  eividences  of  his 
preference  for  this  drug  is  to  be  found  in  the  care  which 


no  GROWTH  OF  MEDICINE 

he  takes  in  describing  how  the  plant  should  be  prepared  for 
remedial  purposes.  "Boil  a  bunch  of  the  plant  in  water 
until  the  mass  is  thoroughly  cooked;  then  cast  it  into  a 
fresh  supply  of  boiling  water  (to  drive  out  still  more  of  its 
bitter  quality) ;  and  finally,  upon  removing  it  from  the 
boiling  water,  place  it  for  conservation  in  a  receptacle 
containing  oil.  When  it  is  required  for  use  add  a  small 
quantity  of  weak  vinegar. ' '  Galen,  in  commenting  jocosely 
upon  the  stress  which  Erasistratus  lays  upon  these  details, 
makes  the  remark:  ''As  if  our  domestics  did  not  know 
how  to  cook  a  bunch  of  chicory ! ' ' 

Speaking  of  the  effects  produced  by  venom  when  one  is 
bitten  by  a  poisonous  snake,  Erasistratus  remarks  that 
''from  the  effects  which  the  poison  introduced  in  this 
manner  produces,  we  may  derive  a  general  indication  as 
to  how  a  cure  may  be  obtained.  The  poison,  it  will  be  noted, 
destroys  very  quickly  the  parts  with  which  it  comes  in 
contact,  and  then,  by  spreading  throughout  the  body, 
causes  death.  The  thing  to  do,  therefore,  is  to  draw  it  as 
quickly  as  possible  out  of  the  body  and  thus  arrest  its 
further  spread.  To  this  end  the  wound  should  first  be 
enlarged  and  its  sides  scarified;  then,  after  it  has  been 
sucked,  a  cupping  glass  should  be  applied  over  it;  and, 
finally,  it  should  be  cauterized." 

Erasistratus  cultivated  surgery  as  well  as  the  other 
branches  of  medicine.  He  was  a  bold  operator,  as  may  be 
inferred  from  the  fact  that,  in  cases  of  scirrhus  or  other 
variety  of  tumor  of  the  liver,  he  did  not  hesitate  to  incise 
the  skin  and  overlying  integuments,  and  then,  after  the 
peritoneal  cavity  had  been  opened,  to  apply  directly  to  the 
seat  of  the  disease  such  medicaments  as  seemed  to  him 
appropriate.  On  the  other  hand,  he  did  not  approve  of 
paracentesis  abdominis  in  cases  of  dropsical  effusion,  as  a 
means  of  evacuating  the  fluid  accumulated  in  the  peritoneal 
cavity. 

It  appears  that  the  disciples  and  successors  of  Herophilus 
and  Erasistratus  soon  abandoned  the  exact  methods  which 
these  two  great  masters  had  inaugurated  and  which,  in  a 
comparatively  short  time,  had  produced  such  admirable 


ERASISTRATUS  AND  HEROPHILUS         111 

results,  and  then  they  fell  back  into  the  less  arduous,  the 
easy-going  ways  of  speculation.  Only  a  very  few  had 
sufficient  strength  of  character  to  walk  in  the  older  path- 
way, and  among  the  number  were  some  who  left  Alexandria 
and  established  schools  in  the  other  cities — as,  for  example, 
Zeuxis,  who  organized  a  new  centre  of  medical  teaching  at 
Laodicea,  in  the  interior  of  Asia  Minor,  and  Hikesios,  who 
founded  another  school  at  Smyrna,  on  the  seacoast  of 
Lydia.  It  is  not  strange,  therefore,  that  before  many  years 
had  elapsed  the  two  original  schools  at  Alexandria  died  a 
natural  death.  As  Pliny  aptly  writes,  **It  was  so  much 
more  comfortable  to  sit  on  the  benches  of  the  schools  and 
have  learning  poured  into  your  ears  than  to  wander  daily 
through  the  desert  outside  in  search  of  other  nourishing 
plants. "  As  a  further  result  of  this  deadness  of  the  schools 
at  Alexandria  (that  is,  of  the  sect  of  the  Dogmatics)  the 
more  serious-minded  physicians  espoused  with  eagerness 
the  side  of  the  Empirics — a  sect  which  developed  about  this 
time,  but  which  did  not,  it  must  be  confessed,  hold  out  much 
hope  of  solving  the  physiological  and  pathological  problems 
of  the  day,  but  which  nevertheless  satisfied  in  some  measure 
their  needs  as  practitioners. 

Philinus  of  Cos  (286  B.  C.)  was  looked  upon  as  the 
founder  of  the  school  of  the  Empirics,  and  among  its  most 
distinguished  disciples  were:  Serapion  of  Alexandria 
(279  B.  C),  Glaucias,  Apollonius  Biblas,  and — perhaps  the 
most  celebrated  of  them  all — Herakleides  of  Tarentum 
(242  B.  C),  who  did  such  excellent  work  in  the  department 
of  pharmacology.  It  was  he,  for  example,  who  defined 
more  precisely  than  had  been  done  by  any  one  of  his 
predecessors  the  proper  manner  of  employing  opium.  In 
addition,  he  wrote  a  commentary  on  the  Hippocratic 
works  and  also  separate  treatises  on  medical,  surgical  and 
pharmaceutical  topics.  In  the  latter  category  belongs  his 
book  entitled  **A  Military  Pharmacopoeia."  Last  of  all, 
Apollonius  Mus,  a  distinguished  follower  of  Herophilus, 
deserves  to  be  mentioned  because  it  was  he  who  perfected 
the  preparation  of  castor  oil.  At  a  still  later  date  (158 
B.  C.)  Zopyrus  proved  himself  to  be  a  most  worthy  sue- 


112  GROWTH  OF  MEDICINE 

cesser  to  Herakleides.  It  was  he  who  first  classified  drugs 
according  to  the  effects  which  they  produce,  and  he  also 
invented  or  discovered  the  preparation  named  ''ambrosia," 
a  general  antidote  for  poisons  of  all  kinds.  Kings  and 
princes  were,  at  that  period,  in  constant  fear  of  being 
poisoned,  and  so  it  came  about  that  those  who  were  skilled 
in  the  knowledge  and  preparation  of  drugs  were  greatly 
stimulated  by  their  royal  patrons  to  find  efficient  antidotes. 
It  is  narrated  that  Attains  Philometer,  King  of  Pergamum, 
the  native  city  of  the  famous  physician  Galen,  and  Mithri- 
dates  Eupator,  King  of  Pontus,  cultivated  poisonous  plants 
in  their  gardens  and  tried  the  effects  of  the  poisons  distilled 
from  them  on  criminals.  They  also  encouraged  in  every 
possible  way  the  preparation  of  antidotes;  and  thus  was 
compounded  a  mixture  which  even  to-day  is  still  known  by 
the  name  of  ^^Mithridaticum."  For  centuries  it  was  a  very 
popular  remedy  for  poisoning  by  snake-bite.  Le  Clerc 
states  that  one  of  the  first  things  that  the  great  Roman 
general  Pompey  did,  after  conquering  Mithridates  and 
gaining  possession  of  his  palace  (about  64  B.  C),  was  to 
have  a  careful  search  made  for  the  recipe  of  this  famous 
antidote.  Upon  finding  it  he  was  surprised  to  learn  what 
simple  ingredients  it  was  composed  of — viz.,  ''20  leaves 
of  rue,  a  pinch  of  salt,  two  nuts,  and  two  dried  figs. ' '  The 
theriacum,  which  one  hundred  years  later  was  modeled 
after  the  Mithridaticum,  contained  a  great  deal  of  honey 
and  a  large  number  of  unimportant  drugs,  introduced — as 
Pliny  claims — "to  magnify  the  importance  of  the  apothe- 
cary's art,  rather  than  to  increase  the  curative  effects  of 
the  remedy." 

The  scepticism  which  already  at  that  period  had  begun 
to  take  possession  of  many  of  the  best  minds  manifested 
itself  in  the  form  of  a  disbelief  in  the  possibility  of 
discovering  full  scientific  truth,  and  men  therefore  taught 
the  doctrine  that  the  human  understanding  is  not  capable 
of  attaining  anything  higher  than  probability.  The  accept- 
ance of  such  a  doctrine  naturally  acted  as  a  powerful 
hindrance  to  all  further  original  research.  And  so  the 
Empirics  neglected  the  study  of  anatomy  and  physiology 


ERASISTRATUS  AND  EEROPHILUS         113 

as  something  quite  superfluous  and  unprofitable.  They 
gave  no  further  thought  to  the  causes  of  disease,  and  were 
quite  satisfied  simply  to  observe  its  manifestations,  to 
investigate  the  factors  which  appeared  to  bring  it  into  a 
state  of  activity,  and  to  search  for  the  means  of  eifecting 
a  cure.  In  carrying  on  work  of  this  character,  they  of 
course  derived  help,  not  only  from  their  own  experience, 
but  also  from  that  of  others — which  latter  became  in  time 
a  matter  of  history.  When  they  encountered  new  expe- 
riences and  were  unable  to  supply  a  satisfactory  expla- 
nation they  resorted  to  a  third  method — that  of  reasoning 
by  analogy.  Upon  this  triple  support — one's  own  indi- 
vidual experience,  the  experience  of  others  stored  up  in 
the  form  of  history,  and  reasoning  by  analog}^ — rested  the 
entire  structure  of  empiricism. 

Strange  as  it  may  at  first  appear,  the  science  of  medicine 
from  this  time  onward  made  no  further  conspicuous 
progress  until  the  middle  of  the  seventeenth  century  of  the 
present  era.  In  certain  branches  of  practical  medicine — 
as,  for  example,  pharmacology,  obstetrics  and  general 
surgery,  and  also  in  certain  special  departments — the 
Empirics  made  a  number  of  material  additions  to  our 
knowledge;  but  in  all  essential  particulars  the  toiedical 
science  taught  throughout  this  period  of  about  two  thou- 
sand years  varied  but  little  from  that  taught  at  Alexandria 
one  hundred  or  two  hundred  years  before  the  birth  of 
Christ.  This  extraordinary  phenomenon  of  almost  com- 
plete arrest  of  development  for  so  long  a  period  of  time 
should  not  excite  surprise,  for  something  of  a  similar 
nature  has  certainly  occurred  in  other  departments  of 
human  knowledge. 

The  further  history  of  the  medical  sects  which  flourished 
under  the  Ptolemies  and  for  a  short  time  afterward,  when 
Alexandria  became  a  colony  of  the  Roman  Empire,  need 
not  detain  us  long.  Daremberg  furnishes  a  chronological 
chart  of  the  physicians  who  played  a  more  or  less  prominent 
part  in  the  work  of  these  sects,  and  from  this  it  appears 
that  they  numbered  thirty-four  in  all — ten  followers  of 
Herophilus,  fourteen  of  Erasistratus,  and  ten  Empirics. 


114  GROWTH  OF  MEDICINE 

Callamachur  and  Bacchius,  who  belonged  to  the  first  of 
these  groups,  deserve  to  be  mentioned  because  they  were 
its  most  distinguished  members  and  because  they  were  the 
first  physicians  who  wrote  commentaries  on  the  writings 
of  Hippocrates.  In  the  sect  of  the  Empirics  the  next  in 
importance  after  Philinus  of  Cos  is  Serapion  of  Alex- 
andria. Mantias,  another  disciple  of  Herophilus,  gained 
considerable  reputation  from  the  fact  that  he  was  the  first 
to  collect  together  into  a  single  treatise  the  different 
pharmaceutical  formulae  that  were  then  in  general  use. 
He  was  also  an  authoritative  writer  on  surgical  topics. 

Certain  Branches  of  Medical  Work  Begin  to  Assume 
more  Distinctly  the  Character  of  Specialties.- — At  the  time 
of  Hippocrates  there  were  no  specialists,  or  at  least  none 
who  received  any  sort  of  official  recognition  from  the 
general  body  of  physicians ;  and  yet,  there  were,  even  then, 
a  few  practitioners  who  devoted  themselves  preferably  to 
the  treatment  of  certain  maladies,  like  the  affections  of  the 
eye  and  the  teeth;  and,  beside  these,  there  were  undoubt- 
edly, in  the  larger  communities,  men  who  were  ready  and 
competent  to  undertake  the  more  serious  surgical  opera- 
tions. But  even  these  men,  as  appears  from  the  language 
of  the  so-called  Hippocratic  oath,  could  not  honorably 
perform  an  operation  for  stone  in  the  bladder;  this 
particular  work  having  been  left  from  time  immemorial 
entirely  in  the  hands  of  the  lithotomists,  a  class  of  men 
who  performed  no  other  kind  of  surgery  and  who,  in 
fact,  were  considered  outside  the  pale  of  the  medical 
profession — ^merely  surgical  artisans. 

During  the  Alexandrian  period  the  attitude  of  the  best 
physicians  with  reference  to  specialization  in  medical 
practice  evidently  underwent  a  change, — not  a  very  marked 
one,  it  is  true,  but  yet  sufficient  in  degree  to  attract  some 
attention.  We  read,  for  example,  that  a  certain  Demetrius 
of  Apamea,  a  follower  of  Herophilus,  was  skilled  as  an 
obstetrician  and  was  also  a  clever  diagnostician;  that 
Andreas  of  Carystus,  another  disciple  of  Herophilus  and 
the  physician  upon  whose  authority  the  incredible  story 
of  the  burning  of  the  Cnidian  archives  by  Hippocrates  was 


ERASISTRATUS  AND  HEROPHILUS         115 

spread  abroad,  was  considered  at  this  time  an  expert  in  the 
science  of  obstetrics;  that,  toward  the  end  of  the  period 
(first  century  B.  C),  Alexander  Philalethes,  a  disciple  of 
Herophilus  and  well  known  as  an  author  of  treatises  on  the 
pulse  and  on  the  doctrines  taught  by  different  physicians 
of  that  period,  acquired  widespread  celebrity  as  a  gynae- 
cologist; that  Straton,  a  disciple  of  Erasistratus,  had 
gained  considerable  distinction  as  a  gynaecologist;  and, 
finally,  that  two  physicians — Gains  of  Naples  and  Demos- 
thenes of  Marseilles  (Massilia) — were  widely  celebrated 
for  their  skilfulness  in  the  treatment  of  eye  diseases.  The 
latter  was  also  a  successful  author,  for  his  treatise  on 
ophthalmology  retained  its  popularity  down  to  the  Middle 
Ages.  All  these  men,  it  should  be  noted,  were  directly  and 
indirectly  connected  with  the  work  at  Alexandria,  and  were 
physicians  of  some  degree  of  prominence.  It  is  fair  to 
assume,  therefore,  that  specialization  in  medical  practice 
had  by  this  time  become  an  accepted  fact  and  was  certainly 
not  frowned  upon  by  those  in  authority.  The  result  is 
entirely  in  accord  with  what  might  be  expected  from  a  body 
of  physicians  as  enlightened  as  were  the  men  gathered 
together  at  Alexandria  during  the  centuries  immediately 
preceding  and  that  immediately  following  the  birth  of 
Christ;  but  many  additional  centuries  were  yet  to  elapse 
before  anything  like  the  well-defined  specialism  of  modern 
times  was  to  become  an  established  fact. 


CHAPTER  XI 

ASCLEPIADES,    THE    INTRODUCER    OF    GREEK 
MEDICINE  INTO  ROME 

The  seventh  Ptolemy,  Ptolemy  Euergetes  or  Physcon, 
whose  reign  lasted  from  146  to  117  B.  C,  drove  all  men  of 
learning  away  from  Alexandria  and  closed  the  famous 
schools  in  that  city.  It  was  only  a  few  years  after  these 
events,  and  at  a  time  when  that  city  was  fast  losing  its 
supremacy  as  the  great  centre  of  medical  learning,^  that 
there  appeared  at  Rome  a  Greek  philosopher  and  physician 
who  was  destined  to  become  the  founder  of  a  new  set  of 
medical  ideas  and  of  a  new  kind  of  medical  practice.    Being 

1  After  Alexandria  first  came  under  Eoman  rule  (about  30  B.  C.)  member- 
ship in  the  Museum  was  granted  to  athletes  and  other  men  of  no  education, 
and  it  is  said  that  even  before  that  time  Ptolemy  Euergetes,  who  had  reopened 
the  schools  during  the  latter  part  of  his  reign,  bestowed  some  of  the  important 
positions  upon  men  who  were  simply  his  favorites.  The  library  of  the  Museum 
was  seriously  damaged  by  fire  at  the  time  when  Julius  Caesar  was  being 
besieged  in  Alexandria  by  the  inhabitants  of  that  city,  and  was  at  last  wholly 
destroyed  by  Amrou,  the  Lieutenant  of  the  Caliph  Omar,  in  A.  D.  651.  The 
truth  of  this  extraordinary  tale  regarding  the  burning  of  books  belonging  to 
the  library  at  Alexandria  in  the  seventh  century  is  seriously  doubted  by 
Sismondi  (Histoire  de  la  Chute  de  I'Empire  Bomain,  Vol.  II.,  p.  57).  "It 
was,"  he  says,  "published  for  the  first  time,  by  Abulpharagius,  about  six 
centuries  after  the  event  is  supposed  to  have  occurred.  And  yet  the  con- 
temporaneous national  historians,  Entychius  and  Elmacin,  make  no  mention 
of  it  whatever.  An  act  of  this  nature,  furthermore,  would  be  in  direct  conflict 
with  the  precepts  of  the  Koran  and  with  the  profound  respect  which  the 
Mohammedans  habitually  entertain  for  every  scrap  of  paper  on  which  the 
name  of  God  happens  to  be  written," 

Under  the  later  rule  of  the  Eomans,  Alexandria  regained  a  good  deal  of 
its  literary  importance  and  also  became  a  chief  seat  of  Christianity  and 
theological  learning;  but  as  a  centre  of  medical  influence  its  glory  had  long 
since  departed. 


ASCLEPIADES  117 

a  man  of  general  cultivation  and  attractive  personality, 
and  not  afraid  to  encounter  the  prejudices  and  ill  will  which 
almost  always  greet  a  foreigner  when  he  first  establishes 
himself  in  a  strange  country  and  among  a  people  of  a 
different  race,  he  soon  overcame  those  obstacles  and  was 
eventually  successful  in  making  Rome  the  starting-point 
and  centre  of  the  best  medical  thought  and  practice  of  that 
period  of  the  world's  history.  To  understand  clearly, 
however,  the  character  of  the  work  which  Asclepiades 
accomplished  in  the  city  which  was  soon  to  be  the  capital 
of  the  world  as  then  known,  it  is  desirable  that  a  brief 
account  should  be  given  of  the  condition  of  medical  affairs 
in  Rome  at  the  time  of  his  arrival. 

The  Practice  of  Medicine  at  Rome  During  the  Century 
Immediately  Preceding  the  Christian  Era. — Foreigners 
were  not  encouraged  to  settle  in  Rome  until  toward  the 
latter  part  of  the  second  century  B.  C,  and  consequently 
the  treatment  of  the  sick  in  that  city  maintained  its 
distinctly  Roman  character  for  an  unusually  long  time. 
In  the  households  of  the  better  classes  the  head  of  the 
family  commonly  prescribed  for  any  illness  which  might 
befall  its  members.  In  not  a  few  instances  one  of  the 
slaves — who  was  known  as  a  servus  medicus,  and  who 
might  perfectly  well  have  been  a  regularly  educated  Greek 
physician — took  charge  of  the  patient  in  place  of  the.^ 
master  of  the  house.  A  book  of  domestic  remedies  was  the 
usual  source  of  information  from  which  the  latter  derived 
his  knowledge  of  therapeutics.  Marcus  Porcius  Cato,  the 
distinguished  Roman  censor  (234-149  B.  C),  was  the 
author  of  one  of  the  most  popular  of  Jkese  books  of  recipes. 
The  text  of  this  work  has  come  down  to  our  time.  There 
were,  at  this  period,  no  regularly  established  physicians 
and  no  such  thing  as  a  medical  practice.  For  several 
hundred  years  the  Romans  were  almost  constantly  at  war 
with  the  neighboring  tribes  or  nations,  and  this  life  of 
outdoor  exposure  and  active  exercise  kept  them  free  from 
the  numerous  and  very  varied  bodily  ills  of  the  later 
generations.  This  state  of  society  alone  was  quite  sufficient 
to  prevent  the  thoroughly  trained  physicians  of  Greece  and 


118  GROWTH  OF  MEDICINE 

Alexandria  from  settling  in  Rome.  But  there  were  still 
other  forces  at  work  which  greatly  delayed  their  taking 
such  a  step,  viz.,  the  unwillingness  on  the  part  of  the 
authorities  to  grant  to  foreigners  the  rights  of  citizenship, 
and  the  very  strong  prejudice  which  the  Roman  aristocracy 
cherished  with  regard  to  the  Greek  nation.  Some  idea  of 
the  strength  of  the  latter  feeling  may  be  gathered  from  the 
letter  which  Cato  the  Censor,  perhaps  the  most  influential 
citizen  of  Rome  at  that  time,  wrote  to  his  son  Marcus. 
Daremberg  gives  the  following  quotation  from  this  epistle : 
'  *  The  Greeks  are  a  perverse  and  unteachable  race.  Believe 
that  an  oracle  is  speaking  to  you  when  I  say — Every  time 
that  the  Greeks  bring  to  us  some  branch  of  knowledge  they 
will  not  fail  to  corrupt  our  manners;  and  it  will  be  far 
worse  for  us  if  they  should  send  us  their  physicians,  for 
they  have  bound  themselves  by  an  oath  to  kill  all  Bar- 
barians by  the  aid  of  medicine — and  they  have  the  insolence 
to  reckon  us  also  as  Barbarians.  Remember  that  I  have 
forbidden  you  to  call  in  a  physician."  Daremberg  adds: 
**The  old  man  Cato  must  have  been  very  simple-minded 
to  believe  for  a  moment  that  physicians  would  be  such 
egregious  fools  as  willingly  to  kill  the  patients  from  whom 
they  derive  their  support. ' '  But  even  this  strong  prejudice 
on  the  part  of  the  Roman  aristocracy  had  to  give  way  in 
course  of  time  to  forces  of  a  much  stronger  character. 
During  the  second  century  B.  C,  the  Romans,  no  longer 
fearing  the  encroachments  of  their  warlike  neighbors  and 
having  overcome  all  danger  of  an  invasion  on  the  part  of 
their  once  powerful  Carthaginian  foe,  entered  upon  a  career 
of  conquest.  The  capture  of  an  ever  increasing  number 
of  cities  and  towns  in  Greece,  Asia  Minor,  Egypt  and 
Africa  brought  great  wealth  to  Rome,  and,  with  it,  increas- 
ing luxury,  an  increase  in  the  prevalence  and  variety  of 
diseases,  and  an  increased  need  of  men  who  were  competent 
to  deal  successfully  with  such  diseases.  The  physicians 
who  first  attempted  to  meet  this  need  were  men  of  an 
inferior  stamp,  to  whom  the  situation  appeared  simply  to 
afford  an  excellent  opportunity  for  making  money;  and 
very  naturally  they  failed  to  gain  the  respect  and  confidence 


ASCLEPIADES  119 

of  the  better  citizens.  At  a  later  date  Julius  Caesar,  who 
was,  at  that  time,  Consul  (about  90  B.  C),  extended  the 
right  of  citizenship  to  all  foreign  physicians  who  were 
practicing  in  Rome,  and  thus  was  removed  one  of  the 
greatest  obstacles  which  prevented  the  better  class  of  Greek 
medical  men  from  settling  in  that  city. 

More  than  a  hundred  years  before  the  time  of  which  I 
am  speaking  {i.e.,  about  218  B.  C),  a  Greek  physician 
named  Archagathus  had  the  courage  to  take  up  his  abode 
in  Rome.  He  was  the  son  of  Lysanias,  a  native  of  Pelo- 
ponnesus. At  first  he  appeared  to  gain  the  favor  of  the 
community  in  which  he  practiced,  for  they  bought  and 
placed  at  his  disposal  a  shop,  or  office,  in  the  cross-way  of 
Acilius,  and  gave  him  the  name  of  vulnerarius — healer  of 
wounds.  Later,  however,  they  disliked  his  rather  too  free 
use  of  the  knife  and  the  actual  cautery,  and  thereafter  he 
was  spoken  of  as  the  carnifex,  or  executioner.  Medicine 
was  thus  brought  into  disrepute  and  we  hear  nothing 
further  about  physicians  in  Rome  for  more  than  a  cen- 
tury— that  is,  until  about  90  B.  C,  when  Asclepiades,^  a 
native  of  the  city  of  Prusa,  Bithynia  (northwest  part  of 
Asia  Minor),  made  his  appearance  in  that  city.  At  first  he 
taught  rhetoric,  but,  finding  this  occupation  unprofitable, 
he  began  the  practice  of  medicine.  Pliny  says  that  he 
acquired  a  knowledge  of  this  art  through  the  studies  which 
he  carried  on  after  his  arrival  in  the  city  of  Rome,  but 
Neuburger  makes  the  statement  that  he  began  the  study 
of  rhetoric,  philosophy  and  medicine  in  his  youth  and  then 
spent  some  time  in  perfecting  his  knowledge  at  Parion,  a 
city  of  Mysia  on  the  Hellespont,  at  Athens,  and  probably 
also  at  Alexandria. 

As  a  practitioner  Asclepiades  appears  to  have  met  with 
unusual  success.  He  was  well  educated  and  possessed  of 
agreeable  manners,  and  was  the  friend  as  well  as  the 
physician  of  Cicero,  one  of  the  most  polished  men  of  whom 
history  furnishes  us  any  knowledge.  He  was  also  on  terms 
of  intimacy  with  Atticus  and  other  eminent  citizens  of 

2  Asclepiades  was  not  a  descendant  of  Aesculapius,  as  one  would  naturally 
infer  from  the  name  which  he  bore. 


120  GROWTH  OF  MEDICINE 

Rome.  The  possession  of  such  friends  was  more  than 
sufficient  to  render  him  one  of  the  favored  and  prosperous 
physicians  of  his  day  in  that  city.  As  Meyer-Steineg  aptly 
says,  *'he  owed  not  a  little  of  his  success  to  the  happy 
manner  in  which  the  scientist,  the  clever  physician,  and — 
to  a  slight  degree — the  charlatan  were  combined  in  his 
character."  The  following  anecdote  which  is  told  of  him 
by  Lucius  Apuleius  shows,  on  the  one  hand,  that  he 
possessed  remarkably  keen  powers  of  observation,  and, 
on  the  other,  that  there  were  some  grounds  for  the 
charge  that  his  behavior  was  at  times  somewhat  theatrical 
in  character: — 

One  day,  as  Asclepiades  w?is  returning  to  the  city,  from  his 
place  in  the  country,  he  observed  the  approach  of  a  long 
funeral  procession.  Desiring  to  learn  whether  the  deceased  was 
a  person  of  his  acquaintance,  and  also  in  the  hope  of  perhaps 
gaining  other  information  of  a  professional  nature,  he  approached 
as  nearly  as  possible  to  the  bier.  The  face  of  the  corpse  was 
anointed  with  sweet-smelling  ointments  over  which  spices  had 
been  sprinkled;  but,  notwithstanding  this,  he  was  able  to  detect 
certain  signs  which  led  him  to  suspect  that  the  man  might  not 
yet  be  dead;  and  accordingly  he  examined  the  body  very  closely 
and  thus  satisfied  himself  that  such  was  indeed  the  fact.  Where- 
upon he  called  aloud  that  the  man  was  still  alive,  and  told  the 
bearers  to  extinguish  the  torches,  to  carry  away  the  materials  for 
the  pyre,  and  to  remove  the  funeral  feast  from  the  grave  to  a  table. 
Some  at  once  objected  to  the  carrying  out  of  these  measures  and 
made  sarcastic  remarks  about  the  healing  art — probably  because 
they  were  already  in  possession  of  the  man's  estate,  and  were  afraid 
that  they  might  have  to  give  it  up.  The  more  influential  ones, 
however,  insisted  that  the  physician's  words  should  be  heeded. 
Then  Asclepiades,  notwithstanding  the  opposition  which  was  made 
by  the  relatives,  succeeded  in  securing  a  brief  delay,  during  which 
he  had  the  supposed  corpse  removed  to  his  own  house.  Restorative 
measures  were  employed,  respiration  was  re-established,  and  the 
man  was  brought  back  to  life.  At  the  succeeding  festivities 
unlimited  praise  was  bestowed  upon  the  wise  physician. 

Whether  this  tale,  which  I  have  copied  from  Neuburger, 
is  true  or  not,  it  seems  to  fit  in  well  with  the  bold  and 


ASCLEPIADES  121 

independent  character  of  Asclepiades  as  it  is  revealed  to 
us  by  the  different  writers  of  the  history  of  medicine.  In 
his  comment  upon  this  narrative  the  distinguished  Viennese 
historian  makes  the  remark  that  Asclepiades  was  very 
conceited,  and — like  most  reformers — showed  a  disposition 
to  ignore  the  work  accomplished  by  his  predecessors.  He 
also  expresses  the  belief  that  Asclepiades  possessed  a 
leaning  toward  the  methods  of  the  charlatan;  the  episode 
just  narrated  revealing  a  love  for  theatrical  display  in  his 
professional  activity.  On  the  other  hand,  in  the  further 
course  of  the  chapter  which  he  devotes  to  this  famous 
Eoman  physician,  Neuburger  gives  fuller  recognition  to 
the  value  of  the  services  which  he  rendered  to  medicine, 
and  thus,  in  the  light  of  these  services,  one  is  justified  in 
overlooking  any  little  weaknesses  of  character  which  he 
may  have  displayed.  Perhaps  the  most  important  of  the 
services  which  Asclepiades  rendered  was  that  of  having 
introduced  Greek  medicine  into  Rome — an  important  con- 
necting link  in  the  transmission  of  medical  knowledge  from 
Greece  to  Modern  Europe. 

The  Views  of  Asclepiades  with  Regard  to  Physiology 
and  Pathology. — The  human  body,  according  to  the 
philosophy  of  Asclepiades,  is  composed  of  atoms — that  is, 
small  bodies  which  are  invisible,  have  no  definable  quality, 
are  in  continual  motion,  through  mutual  pressure  undergo 
modifications  in  form,  and  break  up  into  innumerable 
smaller  fragments  or  particles  that  differ  both  in  size  and 
in  shape.  The  arrangement  of  these  small  bodies  is  such 
that  intercommunicating  spaces  or  pores  are  left  between 
them,  and  through  these  channels  flows  a  sap  or  juice 
containing  larger  and  smaller  particles;  the  larger  ones 
composed  of  blood,  and  the  smaller  of  vapor  or  heat. 
Health,  according  to  Asclepiades,  is  that  state  in  which  the 
primitive  atoms  are  properly  distributed  or  placed  and  the 
flow  of  the  juices  in  the  pores  takes  place  normally.  When, 
however,  the  flow  is  arrested  and  the  primitive  atoms  are 
disordered  in  their  relations  to  each  other  and  to  the  pores, 
or  when  the  elements  composing  the  fluid  contents  of  the 
latter  become  mixed,  disease  results.     Alterations  in  the 


122  GROWTH  OF  MEDICINE 

pores  themselves,  as  contradistinguished  from  the  fluid 
contained  within  them,  may  also  cause  disease.  Farther 
on,  when  the  proper  time  arrives  for  considering  the  sect 
of  the  Methodists,  I  shall  have  occasion  to  discuss  this 
subject  again,  and  particularly  that  part  of  it  which  relates 
to  pathology.  In  the  meantime,  however,  I  cannot  resist 
the  impulse  to  say  a  few  words  about  the  remarkable 
insight  possessed  by  Asclepiades  into  the  manner  of 
construction  of  the  human  body,  as  manifested  by  this  very 
brief  but  very  significant  anatomical  and  physiological 
description.  Upon  a  first  reading  one  might  easily  get  the 
impression  that  Asclepiades  has  reference  to  only  one  kind 
or  system  of  *' pores"  or  channels — viz.,  such  as  serve  for 
the  circulation  of  tissue  juices  alone.  But,  upon  a  closer 
scrutiny  of  the  text,  one  finds  some  warrant  for  suspecting 
that  he  had  in  mind  more  than  one  system  of  such  channels ; 
for  he  states  distinctly  that  the  fluid  circulating  in  these 
pores  contains  larger  particles  composed  of  blood  and 
smaller  ones  which  consist  of  vapor  {spiritus)  or  heat. 
The  question  suggests  itself:  Could  a  man  who  had  no 
knowledge  of  Harvey's  discovery,  who  did  not  possess  a 
microscope,  and  who  at  the  same  time  believed — as  did  all 
the  ancients — that  air  circulated  in  the  arteries  and  blood 
in  the  veins,  come  any  nearer  to  the  actual  truth  than  did 
Asclepiades?  His  description  needs  very  few  alterations 
and  additions  to  make  it  fit  correctly  the  system  of  terminal 
arterio-venous  channels  known  to-day  as  arterioles  and 
capillaries. 

Methods  of  Treatment  Adopted  by  Asclepiades. — The 
prevailing  methods  of  treating  diseases  in  Rome  were  not 
approved  by  Asclepiades,  and  he  lost  no  opportunity  of 
giving  expression  to  this  disapproval.  In  the  first  place, 
he  protested  vigorously  against  the  practice  of  prescribing 
on  every  possible  occasion  purgatives  and  remedies  capable 
of  producing  vomiting.  He  had  a  decided  preference  for 
gentler  measures,  his  idea  being  that  a  physician  should 
cure  his  patients  tuto,  celeriter,  et  jucunde — safely,  quickly 
and  agreeably.  Le  Clerc  adds  that  this  is  a  fine  sentiment, 
but  that  its  realization  in  actual  practice  is   something 


ASCLEPIADES  123 

which  most  physicians  find  it  very  difficult  to  attain. 
Asclepiades  condemned  strongly  the  employment  of 
magical  remedies,  a  practice  which  was  still  much  in  use 
at  that  time  in  Rome,  although  it  was  already  less  common 
than  it  had  previously  been.  Cato  's  collection  of  household 
remedies  contains  a  short  list  of  some  of  these  appeals  to 
man's  superstition.^  In  addition  to  the  remedial  measures 
mentioned  above,  Asclepiades  placed  his  chief  dependence 
on  the  following:  abstinence  from  meat;  the  employment 
of  wine  under  certain  well-defined  circumstances ;  massage 
and  frictions;  baths  of  different  kinds  (it  is  said  that  he 
devised  a  great  variety);  walking;  driving  and  being 
carried  about  in  the  open  air  in  a  litter  or  in  a  boat  on  a 
quiet  river  or  in  the  protected  harbor.  One  of  his  remedies 
in  the  case  of  sleeplessness  consisted  in  having  the  patient 
placed  in  a  suspended  couch  which  could  easily  be  rocked 
from  side  to  side.  As  all  these  measures  were  agreeable 
and  could  at  the  same  time  easily  be  employed  by  almost 
everybody,  they  met  with  general  favor,  and  in  consequence 
Asclepiades  was  looked  upon  by  the  Romans  as  '*a  person 
sent  from  heaven."  As  a  rule,  he  recommended  the 
drinking  of  simple  water,  but  in  certain  cases  (to  be 
mentioned  farther  on)  he  did  not  hesitate  to  advise  the 
taking  of  wine  in  moderation.  He  advocated  tracheotomy, 
in  cases  of  inflammation  of  the  throat,  in  preference  to  the 
then  prevailing  practice — both  very  painful  and  quite 
difficult  to  carry  out — of  introducing  a  tube  of  some  kind 
as  a  means  of  opening  a  passage  for  the  entrance  of  air 
into  the  lungs. 

Le  Clerc  quotes  Galen  as  authority  for  the  statement  that 
Asclepiades,  who  never  hesitated  for  an  instant  to  criticise 
the  different  therapeutic  procedures  of  his  predecessors, 

8  It  would  not  be  easy  to  fix,  even  approximately,  the  date  when  remedies 
of  this  character  ceased  to  find  acceptance  in  the  popular  mind  of  Europeans, 
but  there  can  be  no  doubt  that  they  were  employed  rather  frequently  even 
as  late  as  during  the  eighteenth  century; — indeed,  measures  that  strongly 
smack  of  superstition  are  now  and  then  looked  upon  with  favor  by  the  well- 
educated  members  of  our  modern  society.  For  many  centuries,  however,  they 
have  been  abandoned  by  all  physicians  excepting  those  who  are  unworthy  to 
bear  that  honored  title. 


124  GROWTH  OF  MEDICINE 

did  not  go  so  far  as  to  condemn  wholly  the  practice  of 
bloodletting.  Indeed,  he  was  quite  ready  to  employ  it  in 
the  treatment  of  painful  affections  because,  as  he  claimed, 
the  pain  was  caused  ''by  the  retention  of  the  larger 
particles  or  atoms  in  the  pores  or  channels  of  the  tissues, 
and  hence — as  these  particles  were  composed  of  blood — 
bloodletting  was  the  only  remedy  capable  of  setting  them 
free."  Thus,  he  resorted  to  bleeding  in  pleurisy,  because 
this  affection  is  characterized  by  pain;  but  he  abstained 
from  employing  the  remedy  in  ''peripneumonia"  or 
"inflammation  of  the  lung,"  because  in  most  cases  it  is 
not  accompanied  by  pain;  and  he  also  did  not  approve  of 
its  employment  in  inflammation  of  the  brain  {phrenitis). 
On  the  other  hand,  he  advocated  bleeding  in  epilepsy  and 
all  forms  of  disease  in  which  convulsions  occurred,  and  he 
also  advocated  it  in  cases  of  hemorrhage  of  every  descrip- 
tion. Quinsy  sore  throat  was  another  malady  in  which  he 
drew  blood  freely  from  the  veins  of  the  arm,  of  the  temple 
and  even  of  the  tongue ;  and  in  addition,  when  the  disease 
was  severe,  he  scarified  the  skin  at  suitable  spots  and 
applied  cups  to  the  part.  In  all  these  measures  his  purpose 
was  "to  open  the  pores";  and  when  this  treatment  failed 
he  incised  the  tonsils  or  the  uvula,  and  even,  as  a  last 
resort,  performed  laryngotomy  or  tracheotomy.  In  cases 
of  dropsy  he  employed  paracentesis  abdominis, — that  is, 
he  made  a  very  small  opening  in  the  abdominal  wall  to 
serve  as  an  outlet  for  the  fluid  contained  in  the  peritoneal 
cavity.  From  these  facts  it  is  evident  that  Asclepiades  did 
not  always  abide  by  his  rule  not  to  use  any  but  very  gentle 
remedies. 

Asclepiades  showed,  in  his  manner  of  treating  still  other 
pathological  conditions,  how  different  was  his  practice  from 
that  of  his  predecessors.  In  the  first  place,  he  was  very 
partial,  as  has  already  been  stated,  to  such  extremely  mild 
forms  of  physical  exercise  in  the  open  air  as  one  can  obtain 
from  driving  or  from  being  carried  in  a  litter  or  a  boat. 
He  prescribed  these  measures,  not  merely  for  convalescents 
but  also  for  those,  for  example,  who  were  still  in  the  midst 
of  an  active  fever.    His  idea  was,  that  by  means  of  such 


ASCLEPIADES  125 

very  gentle  forms  of  exercise  the  pores  would  become  less 
clogged  and  would  permit  the  juices  of  the  body  to  flow 
more  freely.  In  cases  of  dropsy,  also,  he  was  in  the  habit 
of  employing  friction  for  precisely  the  same  purpose.  He 
even  used  this  remedy  in  cases  of  inflammation  of  the  brain, 
in  the  expectation  that  he  might  thereby  induce  sleep  for 
these  patients.  Indeed,  this  subject  of  frictions  was  one 
on  which  Asclepiades  wrote  at  greater  length  than  on  any 
other  remedial  agent. 

It  is  a  surprising  fact  that,  in  common  with  Erasistratus, 
he  taught  the  doctrine  that  physical  exercise  was  not  at  all 
necessary  to  persons  in  normal  health.  At  the  same  time 
he  approved  of  it,  when  carefully  graded,  for  those  who 
were  affected  with  bodily  ills  of  a  certain  nature. 

Wine  was  another  remedy  which  Asclepiades  was  fond 
of  prescribing  in  all  sorts  of  maladies,  but  his  rules  in 
regard  to  the  manner  in  which  it  should  be  employed  were 
quite  different  from  those  adopted  by  his  contemporaries. 
A  few  illustrations  will  suffice  to  show  the  different 
conditions  for  which  he  was  wont  to  advocate  the  taking 
of  wine :  He  gave  it,  for  example, — though  probably  much 
diluted  with  water — to  patients  affected  with  fever,  but 
only  after  the  stage  of  greatest  activity  had  been  passed. 
Strange  as  it  may  appear  to-day,  he  was  rather  in  favor 
of  giving  to  patients  ill  with  inflammation  of  the  brain 
(phrenitis)  wine  in  sufficient  quantity  to  produce  intoxi- 
cation; his  belief  being  that  he  could  in  this  way  induce 
drowsiness  and  eventually  sleep) — a  thing  so  desirable  for 
those  affected  with  that  disease.  Further,  he  instructed 
sufferers  from  catarrh  to  drink  twice  or  three  times  as 
much  wine  as  they  usually  drank,  in  consequence  of  which 
instructions  the  patients  found  it  necessary  to  dilute  their 
wine  with  water  to  a  less  degree  than  usual — that  is,  to 
such  a  degree  that  the  proportion  would  be  one-half  of 
each;  thus  showing,  as  Le  Clerc  remarks,  how  sober  the 
ancients  must  have  been  when  they  were  in  perfect  health. 
They  probably — he  adds — drank  their  wine  ordinarily  in 
the  proportion  of  five-sixths  water  to  one-sixth  wine,  or, 
at  most,  three-quarters  water  to  one-quarter  wine. 


126  GROWTH  OF  MEDICINE 

In  some  cases  Asclepiades  prescribed  the  drinking  of 
wine  (particularly  the  wine  of  Cos)  to  which  sea-water  had 
been  added;  his  idea  being  that  the  addition  of  salt  would 
enable  the  wine  to  penetrate  farther  into  the  tissues  and 
thus  open  the  pores  more  freely.  This  idea  of  added  salt 
was  not  original  with  him,  for  Pliny  states  that  in  certain 
parts  of  Oreece  it  was  customary  to  place  casks  filled  with 
new  wine  in  the  sea  and  to  leave  them  there  for  some 
time.  The  wine,  it  was  claimed,  was  rendered  by  this 
procedure  mature  and  pleasanter  to  drink.  They  called 
wine  thus  treated  ''Thalassite  wine"  (from  the  Greek  word 
'^thalassa,"  sea).  In  cases  of  jaundice  he  occasionally 
recommended  the  drinking  of  plain  sea-water,  whereby  the 
bowels  were  stimulated  to  act  more  freely.  Under  ordinary 
circumstances  he  employed,  for  the  relief  of  constipation, 
clysters,  but  he  was  sparing  in  their  use. 

The  remedial  measures  enumerated  above,  together  with 
dieting,  are  those  upon  which  Asclepiades  chiefly  relied  in 
his  practice.  In  acute  diseases  he  made  very  little  use  of 
drugs  that  were  to  be  taken  internally,  but  in  maladies 
of  a  chronic  character  he  employed  them  quite  freely. 
Gargles,  poultices  and  inunctions  are  mentioned  among  the 
external  remedies  which  he  often  prescribed. 

Further  Particulars  Regarding  the  Life  and  Career  of 
Asclepiades. — Le  Clerc  furnishes  a  number  of  details  which 
throw  additional  light  upon  the  career  of  Asclepiades. 
During  the  latter 's  lifetime  his  professional  reputation  was 
very  great.  Lucius  Apuleius,  the  famous  Eoman  satirist 
and  rhetorician,  and  a  contemporary  of  Asclepiades,  calls 
him  the  Prince  of  Physicians,  second  only  to  Hippocrates 
the  Great;  Scribonius  Largus,  a  Roman  physician  and 
writer,  who  flourished  during  the  reigns  of  the  Roman 
emperors  Tiberius  and  Claudius  (37-54  A.  D.),  speaks  of 
him  as  a  great  medical  author ;  Sextus  Empiricus,  a  writer 
remarkable  for  his  learning  and  acumen,  who  lived  in  the 
first  half  of  the  third  century  A.  D.,  calls  him  a  physician 
of  unrivaled  skill;  and  Celsus,  who  is  termed  the  Cicero 
of  physicians,  on  account  of  the  purity  of  his  Latin,  holds 
him  in  high  esteem  as  a  medical  authority.    His  fame  as  a 


ASCLEPIADES  127 

physician  had  spread  to  Asia  Minor,  for  we  are  told  that 
Mithridates,  King  of  Pontus,  who  reigned  from  120  B.  C. 
to  63  B.  C,  and  who  was  a  man  of  great  ability  and  great 
energy,  invited  him  to  take  up  his  residence  at  his  court; 
but  Asclepiades  refused.  Perhaps  a  still  stronger  evidence 
of  his  real  worth  as  a  man  is  to  be  found  in  the  fact  that 
he  was  the  physician  and  personal  friend  of  Cicero. 

Notwithstanding  these  strongly  favorable  estimates  of 
the  ability  of  Asclepiades  there  were  not  a  few  men,  and 
they  too  men  of  great  authority,  who  were  indisposed  to 
give  him  so  conspicuous  a  place  in  the  temple  of  fame. 
Galen,  for  example,  while  admitting  that  he  was  a  very 
eloquent  physician,  maintained  that  he  was  a  sophist,  given 
to  quibbling,  and  disposed  to  contradict  everybody. 
Caelius  Aurelianus,  a  contemporary  of  Galen  and  the 
author  of  the  most  important  practical  treatise  on  Metho- 
dism that  has  come  dowTi  to  our  time,  appears  to  have  held 
the  same  opinion  as  Galen  with  regard  to  Asclepiades. 
The  complete  disappearance  of  all  the  writings  of  the  latter 
author  makes  it  impossible  for  us  at  the  present  time  to 
form  an  independent  judgment  as  to  the  merits  of  these 
conflicting  estimates  of  the  man's  character.  Galen  was 
a  great  admirer  of  Hippocrates  and  it  is  very  likely  that 
he  took  offense  at  the  failure  of  Asclepiades  to  accept  all 
the  teachings  and  therapeutic  methods  of  his  hero.  As  to 
the  reasons  which  led  Caelius  Aurelianus  to  agree  with  the 
estimate  made  by  Galen,  we  know  absolutely  nothing. 

Toward  the  middle  of  the  seventeenth  century  there  was 
discovered  at  Rome,  not  far  from  the  Capena  gate,  a 
portrait  bust  in  white  marble  of  Asclepiades.  It  was 
probably  executed  by  a  Greek  sculptor  residing  in  Rome, 
for,  if  the  work  had  been  done  in  Greece,  the  face  would 
have  been  represented  with  a  beard,  as  are  the  heads  of 
Hippocrates,  Soranus  and  other  celebrated  physicians  of 
antiquity.  The  absence  of  the  beard,  furthermore,  shows — 
according  to  the  opinion  of  antiquarian  experts — that  the 
bust  must  have  been  sculptured  before  the  time  of  the 
Emperor  Claudius  (41-54  A.  D.),  as  he  was  the  first  of  the 
Caesars  to  wear  a  beard.    This  bust,  which  is  a  little  larger 


/■ 


128  GROWTH  OF  MEDICINE 

than  life  size,  is  at  present — if  I  am  rightly  informed — 
in  the  Capitoline  Museum  at  Rome. 

Asclepiades  lived  to  a  great  age.  In  descending,  one 
day,  a  flight  of  steps  he  fell  and  received  injuries  from 
which  he  died. 


CHAPTER  XII 

THE  STATE  OF  MEDICINE  AT  ROME  AFTER  THE 
DEATH  OF  ASCLEPIADES;  THE  FOUNDING  OF 
THE  SCHOOL  OF  THE  METHODISTS 

In  summing  up  the  effects  which  were  produced  by  the 
teaching  and  practice  of  Asclepiades  upon  the  science  and 
art  of  medicine,  Dr.  Meyer-Steineg  makes  the  remark  that 
the  wide  and  ready  acceptance  of  both  depended  largely 
upon  the  personal  character  of  the  man,  upon  the  manner 
in  which  he  carried  out  the  measures  which  he  advocated, 
and  upon  the  fact  that  the  Romans  happened  at  that  period 
of  their  history  to  be  ready  to  respond  favorably  to  such 
new  doctrines  and  therapeutic  methods;  but  that,  as  soon 
as  his  strong  personality  had  ceased  to  exert  its  influence, 
as  it  did  after  he  had  passed  the  active  period  of  his  life, 
and  also  because  Rome  did  not  at  that  moment  possess  any 
physicians  who  were  sufficiently  endowed  with  his  medical 
gifts  and  sagacity  to  perpetuate  his  art,  both  it  and  his 
doctrines  began  to  lose  ground.  Nevertheless,  as  this 
writer  states,  Asclepiades  had  already  succeeded  admirably 
in  preparing  the  way  for  a  further  development  of  the 
healing  art,  and  for  this  valuable  service  full  credit  should 
be  given  him. 

Not  long  after  the  death  of  Asclepiades,  Antonius  Musa,^ 
the  personal  physician  of  the  Emperor  Augustus,  suc- 
ceeded, by  means  of  hydrotherapy,  in  curing  his  royal 
patient  of  a  protracted  gouty  or  rheumatic  affection  from 
which  he  had  been  a  sufferer ;  and,  as  a  mark  of  gratitude 
for  the  cure  which  he  had  effected,  the  Emperor  raised  him 

1  Neither  Haller  nor  Dezeimeris  furnishes  any  biographical  information 
with  regard  to  Musa. 


130  GROWTH  OF  MEDICINE 

to  the  rank  of  a  noble  (about  the  year  10  A.  D.),  erected 
a  statue  in  his  honor  in  the  temple  of  Aesculapius,  and  at 
the  same  time  issued  a  decree  that  from  that  time  forward 
the  physicians  who  practiced  in  Eome  should  be  exempted 
from  taxation  and  from  certain  other  civic  burdens.  These 
privileges,  which  were  afterward  confirmed  by  Vespasian 
(70-79  A.  D.)  and  also  by  Antoninus  Pius  (138-161  A.  D.),' 
were  of  great  advantage  to  the  medical  profession  as  a 
whole.  Julius  Caesar  (100-44  B.  C),  it  will  be  remembered, 
had  already  (about  half  a  century  earlier)  bestowed 
Roman  Citizenship  upon  the  physicians  who  practiced 
their  profession  in  that  city.  Thus,  at  the  time  of  which 
we  are  now  speaking,  the  medical  men  of  Rome  occupied 
the  enviable  position  of  being  on  an  equality  with  their 
fellow  citizens  of  the  better  class,  a  position  which  made 
it  attractive  for  young  men  of  ability  and  of  good  social 
standing  to  enter  the  profession. 

Among  the  numerous  followers  of  Asclepiades  the  most 
distinguished  was  undoubtedly  Themison  of  Laodicea,  a 
city  of  Phrygia,  Asia  Minor,  who  flourished  about  the 
middle  of  the  first  century  B.  C.  When  he  was  well 
advanced  in  years  he  wrote  a  medical  treatise  in  which 
he  developed  a  system  of  pathology  and  therapeutics  that 
was  accepted  as  the  professional  creed  of  the  sect  known 
as  *' Methodists. "  Starting  from  the  doctrine  of  pores  and 
primitive  atoms  taught  by  Asclepiades,  he  laid  great  stress 
upon  the  idea  that  in  disease  all  the  alterations  which 
take  place  in  the  tissues  may  be  classed  in  one  or  the  other 
of  these  two  categories — a  relaxation  ^iJaa;2*m)  or  a  con- 
traction (strictum)  of  the  parts.  To  these  two  categories, 
which  the  Methodists  termed  **  communities, "  and  which 
were  the  only  ones  at  first  accepted  as  a  part  of  their  creed, 
a  third  was  soon  added,  viz.,  that  condition  in  which  both 
relaxed  and  contracted  states  appear  side  by  side,  although 

not  necessarily  both  of  them  developed  to  the  same  degree ; 

« 

2  Antoninus  Pius,  however,  established  the  rule  that  these  privileges  were 
not  to  be  granted  to  all  physicians  indiscriminately,  but  only  to  a  limited 
number;  and,  later  still,  it  was  decided  that  only  the  parish  physicians  were 
entitled  to  receive  them. 


TEE  STATE  OF  MEDICINE  AT  ROME       131 

and  to  this  third  category  or  *' community"  they  applied 
the  term  ^^mixtum."  The  ideas  which  are  here  stated  in 
a  somewhat  crude  and  imperfect  manner  owing  to  my  lack 
of  knowledge  of  all  the  facts,  constitute  the  basis  of  the 
pathology  of  the  ''Methodists" — a  pathology  which  held 
its  own  in  the  domain  of  medicine  during  a  period  of  four 
hundred  years,  and  which — in  contradistinction  to  the 
humoral  pathology  of  Hippocrates — is  justly  entitled  to 
the  name  of  ''solidist  pathology."  This  doctrine,  as  might 
be  expected,  underwent  certain  modifications  during  this 
long  period  of  time,  but  they  were  not  serious  enough  to 
alter  materially  the  fundamental  form  of  the  teaching  as 
it  has  here  been  described. 

Themison  and  his  followers,  like  their  distinguished 
predecessor,  Asclepiades,  possessed  something  more  than 
a  mere  glimmering  of  the  truth  in  pathology  as  we  know 
it  to-day;  and  this  idea  suggests  the  further  thought  that 
Morgagni,  Rokitansky,  Lebert,  Virchow  and  perhaps  others 
whose  names  do  not  now  occur  to  me,  could  scarcely  have 
developed  a  better  pathology  if  they  had  lived  during  these 
first  centuries  of  the  Christian  era — a  period  of  time  when 
public  sentiment  did  not  permit  postmortem  examinations, 
when  Harvey's  discovery  was  not  even  dreamed  of,  when 
the  microscope  was  unknown,  and  when  experimental 
pathology  was  an  impossibility.  Many  centuries  had  still 
to  elapse  before  medicine  could  gain  that  freedom  of  action, 
that  rich  equipment  of  tools,  and  that  stock  of  accumulated 
knowledge  which  enable  her  in  these  days  to  make  such 
giant  strides  forward  as  we  have  witnessed  during  the  past 
twenty  or  thirty  years. 

The  question  will  naturally  arise.  How  did  the  Metho- 
dists decide,  in  the  presence  of  an  actual  case  of  illness, 
which  one  of  these  abnormal  states  (the  laxum,  the  strictum, 
or  the  mixtum)  was  the  condition  that  called  for  medical 
treatment?  The  answer  which  they  gave  to  this  question 
was,  that  the  condition  of  the  different  secretions  and  the 
dejections  furnished  the  principal  indication  as  to  what 
particular  part  or  organ  of  the  body  was  ailing,  and  also 
as  to  what  was  the  nature  of  the  morbid  change  or  process 


132  GROWTH  OF  MEDICINE 

that  produced  the  malady.  When,  for  example,  the  secre- 
tion from  an  organ  or  part  was  excessive,  they  inferred 
that  the  pores  of  such  a  part  were  relaxed  and  distended, 
thus  permitting  an  increased  flow;  and  when  the  secretion 
was  less  than  it  should  be,  they  decided  that  the  pores  were 
contracted.  The  status  mixtus  had  reference  to  those  cases 
in  which  a  condition  of  relaxation  was  observed  in  one  part 
of  the  body,  while  that  of  contraction  was  noted  in  another. 

Neuburger  mentions  the  fact  that  the  Methodists  were 
somewhat  arbitrary  in  their  classification  of  the  different 
diseases,  most  of  the  acute  maladies  being  placed  by  them 
under  the  heading  Status  strictus,  while  they  assigned  the 
majority  of  the  chronic  affections  to  the  category  of  Status 
laxus. 

The  effect  of  the  tendency  of  the  Methodists  to  classify 
and  simplify  all  the  departments  of  medicine  was  not 
wholly  beneficial.  It  conveyed  to  many  the  impression  that 
medicine  might  readily  be  learned  in  the  course  of  a  few 
months,  and  thus  offered  the  temptation  to  inferior 
men  to  choose  the  career  of  physician;  and  yet,  on  the 
other  hand,  it  infused  into  the  art  the  essentially  Eoman 
characteristics  of  orderliness,  simplicity  and  efficiency. 
Anatomy,  for  example,  was  studied  only  so  far  as  a  knowl- 
edge of  this  department  of  medicine  was  necessary  to 
render  the  physician  familiar  with  the  location,  general 
character  and  relations  of  the  different  organs.  There  was 
one  field,  however,  in  which  the  adherents  of  this  school 
displayed  a  high  degree  of  excellence,  viz.,  in  their  descrip- 
tions of  disease ;  and  this  is  especially  true  of  those  written 
by  Caelius  Aurelianus  (fourth  century  A.  D.),  whose 
manner  of  handling  the  subject  of  differential  diagnosis  is 
far  more  thorough  and  satisfactory  than  that  of  any  of  the 
medical  authors  who  preceded  him. 

In  their  treatment  of  disease,  the  Methodists  were  largely 
guided  by  the  principle  of  contraria  contrariis, — i.e.,  in 
those  cases  in  which,  to  the  best  of  their  belief,  a  status 
laxus  existed,  they  administered  astringents,  in  the  hope 
of  thereby  bringing  the  parts  back  more  nearly  to  a 
contracted  condition;  and,  vice  versa,  when  the  diagnosis 


THE  STATE  OF  MEDICINE  AT  ROME       133 

of  status  strictus  was  made,  they  gave  a  relaxing  medicine. 
The  terms  *' laxatives"  and  '* astringents, "  which  are  still 
applied  to  many  drugs,  were  originated  by  the  Methodists. 
Bloodletting,  for  example,  was  one  of  the  remedies  which 
they  used  for  producing  relaxation,  and  an  astringent  was 
employed  when  a  contrary  effect  was  desired.  In  the  list 
of  relaxing  remedial  agents  (aside  from  bloodletting)  were 
placed  the  following:  warm  baths,  poultices,  inunctions 
with  warm  oil,  vapor  baths,  fasting  and  a  restricted  diet, 
diuretics  (very  carefully  watched  and  employed  only  in 
exceptional  cases),  emetics,  diaphoretics  and  laxatives. 
The  following  agents,  on  the  other  hand,  were  classed  as 
contracting,  astringent  and  tonic  remedies:  washing  with 
cold  water,  cold  baths,  the  application  of  cloths  dipped  in 
cold  water,  living  in  cold  air,  strengthening  diet,  wine, 
vinegar,  alum,  narcotics,  etc.  Themison,  it  should  be 
added,  is  the  first  one  among  the  ancient  writers  to  mention 
the  use  of  leeches  as  a  means  of  extracting  blood.  It  does 
not  follow  from  this,  however,  that  he  was  the  discoverer 
of  this  method  of  local  bloodletting ;  for  it  is  highly  probable 
that  this  procedure  had  been  in  common  use  for  many  years 
previous  to  his  time. 

Themison,  as  I  have  before  stated,  was  an  old  man  when 
he  laid  the  foundations  for  Methodism,  and  it  is  not 
probable  that  it  attained  much  importance  as  a  sect  until 
several  years  after  his  death.  Then  Thessalus,  a  native 
of  Tralles,  a  flourishing  commercial  city  of  Asia  Minor, 
and  a  man  who  had  received  his  medical  training  in  one  of 
the  Greek  schools,  materially  added  to  the  body  of  doctrines 
held  by  this  sect,  and  at  the  same  time  rendered  them  more 
acceptable  to  physicians  generally.  He  was  of  humble 
birth,  the  son  of  a  wool  carder,  and  his  education  had  been 
rather  neglected ;  but  he  nevertheless  managed,  by  his  own 
efforts  and  in  no  small'  degree  by  the  unlimited  self- 
confidence  (Galen  calls  it  impudence)  which  he  possessed, 
to  push  his  way  to  the  top  of  the  ladder.'    He  acquired  a 

8  It  seems  almost  unnecessary  to  call  attention  to  the  fact  that  the  subject 
of  these  remarks  is  not  to  be  confounded  with  Thessalus,  the  son  of 
Hippocrates. 


134  GROWTH  OF  MEDICINE 

large  fortune  during  the  reign  of  Nero  (54-68  A.  D.)  and 
apparently  succeeded  in  persuading  this  monarch  that  he 
was  a  great  physician.  Here  are  some  facts  which  appear 
to  justify  Galen's  dislike  for  Thessalus:  In  a  letter  to 
Nero  the  latter  writes:  **I  have  founded  a  new  medical 
sect,  the  only  genuine  one  in  existence.  I  was  forced  to  do 
so  because  the  physicians  who  preceded  me  had  failed  to 
discover  anything  that  is  likely  to  promote  health  or  to 
drive  away  disease ;  even  Hippocrates  himself  having  laid 
down  doctrines  which  are  positively  harmful."  His  vanity, 
according  to  Le  Clerc,  reached  such  a  pitch  that  he  called 
himself  the  *' conqueror  of  physicians."*  Pliny  corrobo- 
rates the  latter  statement  in  the  following  words :  ''When 
he  assumed  the  title  of  'conqueror  of  physicians,'  a  title 
which  was  engraved,  according  to  his  instructions,  on 
his  tomb  in  the  Appian  Way."  Notwithstanding  his 
unbounded  conceit,  Thessalus  appears  to  have  made  several 
important  improvements  in  the  doctrines  of  the  Methodists. 
He  is  also,  as  it  appears,  entitled  to  the  credit  of  having 
been  the  first  to  inaugurate  the  practice  of  giving  sys- 
tematic instruction  at  the  bedside ;  thus  establishing  for  all 
time  a  most  valuable  precedent  for  the  guidance  of  his 
successors. 

"He  was   an   excellent  practitioner  and   an   original   thinker. 

He  was  also  a  prolific  writer,  as  is  shown  by  the  number 

and  variety  of  treatises  which — as  we  are  assured  by  Caelius 
Aurelianus — were  composed  by  him."  The  same  authority  speaks 
of  him  as  "a  leader  among  our  chiefs,"  thus  affording  good  evi- 
dence of  the  degree  of  esteem  in  which  he  was  held  by  the  members 
of  his  own  school.  The  fact  that  pupils  came  in  throngs  to  be 
taught  by  him  shows  clearly  how  thoroughly  he  understood  the 
needs  of  the  physicians  of  Rome.     (Meyer-Steineg.) 

Thessalus,  notwithstanding  his  declaration  that  medicine 
might  readily  be  taught  in  six  months,  wrote  a  larger 
number  of  treatises  on  professional  topics  than  any  student 
of  medicine  could  possibly  read  and  digest  in  the  course  of 

*  larpovlKfis  is  the  word  employed  in  the  original  Greek. 


THE  STATE  OF  MEDICINE  AT  ROME       135 

two  or  three  years.  They  filled  several  large  volumes,  but 
not  one  of  them  is  known  to  exist  to-day.  He  wrote  at  great 
length,  as  we  are  assured,  on  the  subject  of  surgery,  a 
subject  in  which  he  took  an  active  interest.  He  taught  that 
ulcers,  no  matter  in  what  part  of  the  body  they  may  be 
located,  require  the  same  kind  of  treatment. 

If  an  ulcer  is  excavated,  it  is  necessary  to  bring  about  a  filling-up 
of  the  excavation ;  if  its  surface  is  on  a  level  with  the  surrounding 
skin,  the  aim  should  be  to  make  it  cicatrize ;  if  the  growth  of  new 
tissue  is  excessive,  the  redundant  portion  should  be  destroyed  by 
burning  with  caustic ;  and,  finally,  if  the  ulcer  is  of  recent  develop- 
ment and  bleeds  readily,  the  attempt  should  be  made,  by  approxi- 
mating the  edges,  to  effect  an  immediate  healing. 

In  the  treatment  of  chronic  ulcers  which  show  little  or 
no  disposition  to  heal,  and  which,  when  they  do  finally  heal, 
are  very  prone  to  break  open  afresh,  Thessalus  urges  the 
great  importance  of  ascertaining,  if  possible,  the  cause  or 
causes  of  this  behavior.  If  it  be  found  that  the  trouble  is 
due  to  some  weakness  or  abnormal  predisposition  of  the 
part  in  which  the  ulcer  is  located,  or  that  the  condition  of 
the  entire  body  is  probably  the  real  cause  of  the  trouble, 
he  recommends  the  employment  of  ''metasyncritic  reme- 
dies"— that  is,  remedial  measures  which  effect  a  marked 
change  in  the  individual's  vital  processes  throughout  the 
body,  and  also  such  as  exert  an  alterative  effect  upon  the 
ulcer  itself.  Among  the  measures  of  the  first  class  he 
enumerates  the  following:  Various  forms  of  physical 
exercise;  alternately  increasing  and  diminishing  the 
amount  of  nourishment  taken;  and  perhaps  the  taking 
of  an  emetic  at  the  very  commencement  of  the  treatment. 
As  to  the  second  class  of  measures — those  needed  to  bring 
about  a  change  in  the  ulcer  itself — he  makes  the  following 
recommendations :  Remove  from  the  diseased  tissues  as 
much  as  will  restore  the  parts,  as  nearly  as  possible,  to  the 
condition  of  a  healthy  wound,  and  then  adopt  the  treatment 
suited  for  the  latter  condition.  In  cases  in  which  the  ulcer 
heals  and  then  subsequently  breaks  open  again,  it  will 


^ 


136  GROWTH  OF  MEDICINE 

sometimes  be  found  beneficial  to  apply  in  the  neighborhood 
a  plaster  containing  an  irritating  substance  like  mustard, 
the  effect  of  which  is  often  to  change  the  disposition  of  the 
parts.  In  actual  practice  he  recommends  that  the  local 
measures  should  be  employed  first,  and  then,  if  they  fail 
to  accomplish  the  desired  purpose,  the  physician  should 
have  recourse  to  those  enumerated  in  the  first  class — the 
strictly  metasyncritic  remedies. 

It  is  rather  difficult  to  believe  that  a  man  so  full  of 
conceit  and  so  unjust  in  his  criticisms  of  his  predecessors 
as  Thessalus  clearly  was,  could  be  capable  of  formulating 
such  a  concise  statement  of  the  nature  of  chronic  ulcers 
and  such  a  practical  rule  for  their  proper  treatment.  His 
development  of  the  idea  of  ' '  metasyncrisis  " — or  renovation 
of  the  body  (recorporatio),  as  Caelius  Aurelianus  trans- 
lates the  word — seems  to  have  been  original  with  Thes- 
salus.^ The  Methodists,  it  should  be  added,  deserve  special 
credit  for  having  been  the  first  to  introduce  and  carry  into 
eifect  the  systematic  treatment  of  chronic  diseases;  and, 
as  a  general  proposition,  it  may  be  said  that  their  treatment 
of  all  forms  of  disease  was  thoroughly  practical,  free  from 
all  tendency  to  resort  to  magical  methods,  and  based  largely 
on  the  employment  of  such  hygienic  measures  as  the  use 
of  baths  of  different  kinds  (hydrotherapy),  massage, 
moderate  outdoor  exercise,  passive  movements,  sea 
voyages,  fasting,  regulation  of  the  diet,  etc.  One  of  the 
favorite  practices — of  which  Thessalus  was  said  to  have 
been  the  originator — was  to  begin  the  treatment  of  almost 
all  maladies  by  prescribing  an  abstinence  from  all  food  for 
a  period  of  three  full  days.  When  I  come  to  speak  of 
Soranus  and  Caelius  Aurelianus  I  shall  probably  have 
occasion  to  give  further  details  regarding  the  methods  of 
treatment  employed  by  the  Methodists. 

As  a  system,  says  Neuburger,  Methodism  was  not  capable 
of  inaugurating  any  fundamental  advances  in  medicine; 
the  most  that  it  was  able  to  accomplish  was  to  broaden  and 

5  The  word  ' '  metasyncrisis, "  as  we  are  assured  by  Le  Clerc,  was  employed 
first  by  Cassius,  one  of  the  earlier  disciples  of  Methodism,  and  then,  long  after 
the  time  of  Thessalus,  by  Galen,  Oribasius,  Aetius  and  Paulus  Aegineta. 


THE  STATE  OF  MEDICINE  AT  ROME       137 

otherwise  improve  the  domain  of  therapeutics,  and  some 
of  its  wiser  members  were  diligent  in  collecting  and  sifting 
critically  a  large  number  of  valuable  experiences,  which 
were  then  courteously  registered  by  them  to  the  credit  of 
the  sect. 


CHAPTER  XIII 

THE  FURTHER  HISTORY  OF  METHODISM  AT 
ROME,  AND  THE  DEVELOPMENT  OF  TWO  NEW 
SECTS,  VIZ.,  THE  PNEUMATISTS  AND  THE 
ECLECTICS.— A  GENERAL  SURVEY  OF  THE 
SUBJECT  OF  SECTS  IN  MEDICINE 

Among  the  Methodists  there  were  many  physicians  who 
attained  more  or  less  distinction  during  their  professional 
career,  but  only  two  of  them,  beside  those  whose  contri- 
butions to  medical  knowledge  have  already  been  mentioned 
in  these  pages,  gained  sufficient  celebrity  to  justify  me  in 
devoting  some  additional  space  to  the  description  of  the 
work  which  they  accomplished.  Soranus,  of  Ephesus  on 
the  coast  of  Asia  Minor,  and  Caelius  Aurelianus,  of  Sicca 
in  the  north  of  Africa,  are  the  physicians  to  whom  I  have 
reference. 

It  was  Soranus,  says  Le  Clerc,  who  gave  the  finishing 
touches  to  the  system  of  the  Methodists,  and  the  work 
which  he  did  was  of  such  excellence  that  he  may  with 
justice  be  called  the  ablest  and  most  skilful  of  all  the 
members  of  that  school.  Caelius  calls  him  ' '  a  chief  among 
the  leaders  of  our  sect. ' '  He  received  his  medical  training 
at  Alexandria  and  came  to  Rome  about  the  year  100  A.  D. 
His  professional  career  covered  the  period  corresponding 
to  the  reigns  of  Trajan  and  Hadrian  (98-138  A.  D.).  He 
is  known  to  posterity  chiefly  through  his  two  treatises — 
one  on  obstetrics  and  gynaecology  and  the  other  on  acute 
and  chronic  diseases.  The  first  of  these  treatises,  in  the 
original  Greek,  was  rediscovered  in  1838  by  Reinhold 
Dietz,  Professor  of  Medicine  in  the  University  of  Konigs- 


HISTORY  OF  METHODISM  AT  ROME        139 

berg,  Prussia,  and  a  German  translation  of  the  work  (by 
Liineberg  and  Huber)  was  published  in  Munich  in  1894. 
Moschion,  who  was  probably  a  pupil  of  Soranus,  wrote  a 
popular  treatise  on  the  same  subject  for  the  use  of  mid- 
wives,  and  in  this  book  he  has  reproduced  much  of  the 
material  which  is  to  be  found  in  the  work  of  his  master. 
The  treatise  written  by  Caelius  Aurelianus  on  acute  and 
chronic  diseases  is  admitted  by  him  to  be  founded  on  that 
which  Soranus  wrote  on  the  same  subject.  In  fact,  as 
Daremberg  states,  the  work  of  the  former  represents 
almost  a  translation  (into  Latin)  of  Soranus'  treatise. 
The  sources  just  named  are  the  principal  ones  from  which 
our  knowledge  of  this  author  is  derived. 

Soranus  was  a  prolific  writer;  the  treatises  which  he 
wrote  and  which  deal  with  a  great  variety  of  subjects, 
number  thirty  in  all.  The  majority  of  these  works,  how- 
ever, have  been  lost.  He  had  many  followers  and  his 
influence  upon  medical  science  was  very  great,  not  simply 
during  his  lifetime,  but  also  for  several  centuries  after  his 
death.  He  commanded  the  respect  and  confidence  of  the 
opponents  of  Methodism  as  well  as  of  the  members  of  his 
own  sect.  One  of  his  most  pronounced  traits  of  character 
was  his  readiness  to  condemn,  on  every  possible  occasion, 
superstitious  practices,  such  as  the  employment  of  amulets, 
magnets,  etc.  He  was  also  a  very  persistent  and  earnest 
advocate  of  the  gentler  and  more  rational  obstetric  methods. 
For  example,  he  disapproved  of  the  reckless  employment 
of  remedies  for  hastening  the  expulsion  of  the  foetus,  of 
the  practice  of  succussion  (which  was  carried  out  by  the 
aid  of  a  ladder),  of  making  the  pregnant  woman  run  up 
and  down  stairs,  of  a  resort  to  rough  mechanical  procedures 
for  extracting  the  placenta,  etc.  The  following  quotation 
from  one  of  Soranus'  treatises  ( Gynaeciorum,  Lib.  L, 
cap.  19)  reveals  clearly  what  sort  of  a  man  and  physician 
he  was : — 

There  is  a  disagreement;  for  some  reject  destructive  practices, 
calling  to  witness  Hippocrates,  who  says,  "I  will  give  nothing 
whatever  destructive"  and  deeming  it  the  special  province  of 
medicine  to  guard  and  preserve  what  nature  generates.    Another 


140  GROWTH  OF  MEDICINE 

party  maintains  the  same  view,  but  makes  this  distinction,  viz. : 
that  the  fruit  of  conception  is  not  to  be  destroyed  at  will  because 
of  adultery  or  of  care  for  beauty,  but  is  to  be  destroyed  to  avert 
danger  impending  at  parturition,  if  the  uterus  be  small  and  cannot 
subserve  the  perfecting  of  the  fruit,  or  have  hard  swellings  and 
cracks  at  its  mouth,  or  if  some  similar  condition  prevail.  This 
party  says  the  same  thing  about  preventing  conception,  and  with 
it  I  agree. 

(Translated  from  the  Greek  by  the  late  John  G.  Curtis,  M.D., 
of  New  York.) 

Soranus  was  not  only  a  great  obstetrician, — admitted 
by  all  the  authorities  to  have  been  the  greatest  in  ancient 
times, — he  was  also  in  high  repute  for  the  work  which  he 
did  in  other  departments  of  medicine — in  gynaecology, 
for  example,  in  the  instruction  of  midwives,  in  the  manage- 
ment of  children's  diseases,  in  the  diagnosis  and  treatment 
of  both  acute  and  chronic  diseases,  in  surgery,  etc.  While 
in  general  he  adhered  to  the  fundamental  teachings  of 
the  Methodists,  he  did  not  hesitate  to  depart  from  the 
beaten  pathway  of  that  sect  in  his  explanations  of  certain 
pathological  conditions;  for  he  was  more  of  a  clinical 
observer  than  a  sectarian,  and  it  was  probably  his  inde- 
pendent manner  of  thinking  that  gave  the  sect  new  vigor 
and  thus  enabled  it  to  live  on  through  such  a  long  period 
of  time.  Galen,  who  was  not  at  all  disposed  to  speak 
favorably  of  the  Methodists,  says  that  he  tried  a  number 
of  the  remedies  recommended  by  Soranus  and  found  them 
good. 

Caelius  Aurelianus  probably  flourished  during  the  third 
century  A.  D.  The  different  authorities,  however,  do  not 
agree  as  to  the  limits  of  the  period  during  which  he  lived; 
some  saying  that  his  career  antedated  that  of  Galen,  while 
others  claim  that  he  came  upon  the  scene  after  the  death 
of  the  latter,  which  occurred  early  in  the  third  century 
A.  D.  His  chief  merit  appears  to  have  been  that,  through 
his  translation  of  the  writings  of  Soranus  into  Latin,  he 
placed  within  reach  of  the  physicians  of  Rome  the  teachings 
of  that  admirable  diagnostician  and  therapeutist;  for  it 
must  be  remembered  that  the  great  majority  of  the  Roman 


HISTORY  OF  METHODISM  AT  ROME        141 

medical  men  were  not  able  to  read  Greek.  On  the  other 
hand,  Caelins  Aurelianus,  who  was  himself  a  thoroughly 
practical  physician,  deserves  considerable  credit  for  having 
enriched  the  text  of  his  book  with  many  very  appropriate 
examples  (chiefly  with  regard  to  questions  of  diagnosis) 
drawn  from  his  own  personal  experience,  which  must  have 
been  extensive.  During  the  Middle  Ages,  as  we  are 
informed  by  Friedlaender,  this  work  furnished  the  chief 
source  from  which  the  monks  derived  their  knowledge  about 
diseases  and  their  proper  treatment.  The  Latin  in  which 
the  book  is  written  is  described  by  nearly  all  the  authorities 
as  barbaric. 

The  Pneumatists. — Methodism  had  been  established  only 
a  very  few  years  when  Athenaeus  of  Attalia,  a  city  on  the 
coast  of  Pamphylia,  Asia  Minor,  founded  (about  50  A.  D.) 
a  new  sect — that  of  *  *  Pneumatism. "  He  was  not  the  dis- 
coverer of  the  *'pneuma"  or  '* vital  spirit,"  for  that  had 
already  been  admitted  by  the  earlier  schools  of  philosophy 
as  a  fifth  primary  creative  element,  supplementary  to  the 
four  well-known  substances — fire,  air,  earth  and  water. 
He  believed  that  heat,  cold,  moisture  and  dryness  (the 
primary  qualities  of  these  four  bodies)  were  not  the 
veritable  elements  of  living  beings.  Heat  and  cold,  he 
maintained,  were  ** efficient  causes"  and  moisture  and 
dryness  '* material  causes."  To  these  he  added  ''spirit" 
as  a  fifth  element ;  and  he  taught  that  this  spirit  enters  into 
the  formation  of  all  bodies  and  preserves  them  in  what 
may  be  termed  their  natural  state.  It  was  from  the  Stoics, 
more  particularly,  that  Athenaeus  borrowed  this  belief, 
and  it  was  the  latter  fact,  as  Le  Clerc  says,  which  led  Galen 
to  speak  of  Chrysippus — one  of  the  most  famous  of  the 
Stoics — as  ''the  Father  of  the  Sect  of  the  Pneumatists." 

In  his  application  of  the  doctrine  of  Pneumatism  to  the 
science  of  medicine,  Athenaeus  maintained  that  the 
majority  of  diseases  owed  their  origin  to  some  disturbance 
or  disorder  of  the  spirit;  but  it  is  almost  impossible  to 
understand,  from  the  scanty  data  which  have  come  down 
to  us,  what  Athenaeus  really  meant  by  the  term  "spirit," 
and  by  the  expression  "disorder  of  the  spirit." 


142  GROWTH  OF  MEDICINE 

From  the  definition  which  he  gives  of  the  word  ** pulse"  one  is 
justified  in  drawing  the  conclusion  that  he  considered  the  spirit 
to  be  an  actual  substance,  capable  of  undergoing,  to  a  greater  or 
less  degree,  such  changes  as  expansion  and  contraction.  The  same 
obscurity  of  meaning  is  encountered  when  one  endeavors  to  dis- 
cover how  the  new  doctrine  affected  the  practice  of  medicine. 
(Le  Clerc.) 

In  view  of  all  these  circumstances  it  is  not  at  all  sur- 
prising that  Pneumatism  was  not  very  popular  with  the 
physicians  of  Rome,  and  that,  after  a  brief  period  had 
elapsed,  many  of  the  adherents  of  this  doctrine  abandoned 
it  and  gave  their  preference  to  the  more  practical  teachings 
of  the  Methodists.  Meyer-Steineg  goes  so  far  as  to  remark 
that,  to  all  intents  and  purposes,  such  a  thing  as  a  sect  of 
Pneumatists  did  not  exist. 

The  most  prominent  of  the  disciples  of  Athenaeus  were 
Theodorus,  Agathinus,  Herodotus,  Magnus  and  Archigenes. 

Haller  speaks  of  Theodorus  as  the  inventor  of  a  remedy 
which,  as  he  claimed,  cures  all  cases  of  poisoning. 

The  Eclectics. — Agathinus,  a  native  of  Sparta,  was 
the  teacher  of  Herodotus  and  Archigenes.  His  chief 
distinction  is  to  be  found  in  the  fact  that  he  gave  to  the 
offshoot  from  the  school  of  the  Pneumatists  the  name  of 
"Eclectics,"^  his  object  being,  as  we  are  assured  by 
Neuburger,  to  bring  the  three  sects  (Pneumatists,  Empirics 
and  Methodists)  into  closer  union. 

Herodotus — who,  it  is  perhaps  desirable  to  state,  is  a 
different  person  from  the  famous  historical  writer  of  the 
same  name — lived  during  the  latter  part  of  the  first  century 
A.  D.,  and  was  more  closely  allied  to  the  Methodists  than 
to  the  Pneumatists.  It  appears  from  the  text  of  a  fragment 
of  one  of  his  treatises  that  he  wrote  a  description  of  the 
disease  now  called  small-pox  and  directed  attention  to  its 
contagious  character. 

Magnus,  a  native  of  Ephesus  in  Asia  Minor,  is  reported 

1  Le  Clerc  calls  attention  to  the  incorrectness — etymologically  speaking — of 
the  use  of  the  word  "Eclectics"  in  connection  with  a  school  or  sect.  The 
members  of  such  a  body  are  not,  he  says,  "the  chosen  ones"  as  the  term 
signifies,  but  "the  choosers." 


HISTORY  OF  METHODISM  AT  ROME        143 

to  have  been  the  writer  of  a  collection  of  letters  on  medical 
topics  and  also  of  a  history  of  the  discoveries  made  in 
medicine  subsequently  to  the  time  of  Themison. 

Archigenes,  the  fifth  member  of  this  group  of  Pneu- 
matists,  was  born  in  Apamea,  Syria,  and  lived  in  Rome 
under  the  reigns  of  Trajan  (98-117  A.  D.)  and  Hadrian 
(117-138  A.  D.).  Le  Clerc  speaks  of  him  as  belonging  to 
the  Eclectics  rather  than  to  the  Pneumatists.  This  is  a 
matter,  however,  of  small  importance,  as  the  sects  were, 
at  that  period,  very  much  mixed.  The  poet  Juvenal,  who 
was  a  contemporary  of  Archigenes,  refers  to  him  briefly 
as  a  physician  who  had  a  large  practice ;  and  the  historian 
Suidas  says  that  he  wrote  a  great  deal  about  physics  as 
well  as  about  medicine.  That  he  was  esteemed  highly  as 
an  authority  in  practical  surgery  is  shown  by  the  fact  that 
Galen,  when  he  discusses  surgical  topics,  makes  frequent 
quotations  from  the  writings  of  Archigenes.  Only  frag- 
ments of  the  latter,  however,  have  come  down  to  our  time. 
His  popularity  as  a  practitioner  was  very  great;  notwith- 
standing which  he  managed  to  write  several  treatises  on  a 
variety  of  topics — on  the  pulse,  on  feverish  diseases,  on 
the  different  types  of  fevers,  on  local  affections,  on  the 
diagnosis  and  treatment  of  acute  and  chronic  maladies, 
on  the  right  moment  when  surgical  operations  should  be 
performed,  on  drugs,  and  on  therapeutic  procedures  in 
general.  He  applied  ligatures  to  blood-vessels  and  also 
arrested  further  bleeding  from  them  by  passing  needles 
through  the  adjacent  parts  in  such  a  manner  as  to  exert 
pressure  upon  the  vessel  (a  procedure  which  is  termed 
** acupressure ") ;  he  operated  for  the  removal  of  both 
mammary  and  uterine  cancers;  he  employed  the  red-hot 
cautery  iron  for  the  arrest  of  hemorrhage  and  also  for  the 
relief  of  coxalgia,  and  he  was  familiar  with  the  use  of  the 
vaginal  speculum. 

Antyllus,  another  prominent  surgeon  of  that  period, 
joined  the  Methodists  at  a  considerably  later  date.  He 
was  also  the  author  of  an  excellent  treatise  on  surgery,  the 
greater  part  of  which,  unfortunately,  has  been  lost  or 
destroyed. 


144  GROWTH  OF  MEDICINE 

Aretaeus  of  Cappadocia,  a  district  of  Asia  Minor,  lived 
during  the  second  century  A.  D.  He  was  a  man  of  very- 
broad  culture.  From  the  fact  that  he  assigned  an  important 
role  to  the  pneuma,  he  is  usually  classed  among  the 
Pneumatists.  He  does  not  appear,  however,  to  have  taken 
a  very  active  interest  in  the  doctrines  of  that  school,  and 
both  Le  Clerc  and  Daremberg  seem  disposed  to  call  him 
an  Eclectic,  and  we  may  therefore  rank  him  as  one  of  the 
independent  physicians  of  that  period.  It  is  doubtful 
whether  he  ever  practiced  in  Rome.  His  two  treatises — 
one  on  the  causes  and  means  of  identifying  acute  and 
chronic  diseases,  and  the  other  on  the  treatment  of  these 
diseases — are  written  in  Greek,  and  are  characterized  by 
the  clearness  and  simplicity  of  his  descriptions,  which  very 
closely  resemble  those  of  Hippocrates,  and  by  the  soundness 
of  the  advice  which  he  gives  in  regard  to  the  methods  of 
treatment.^  In  his  conceptions  of  what  a  physician  should 
aim  to  be,  Aretaeus  maintained  a  very  high  standard. 
Some  of  his  views  regarding  human  physiology  and 
pathology  are  given  here  very  briefly:  Respiration  serves 
the  purpose  of  cooling  the  warmth  of  the  heart,  and  the 
lungs  are  therefore  prompted  by  the  latter  organ  to  draw 
cool  air  into  their  cavities;  digestion  takes  place  not  only 
in  the  stomach  but  also  in  the  intestinal  canal,  and  owes  its 
origin  to  warmth;  the  cerebral  nerves,  close  to  the  spot 
from  which  they  originate,  cross  from  one  side  to  the  other, 
and  by  the  aid  of  this  fact  paralysis  on  one  side  of  the  body 
may  be  explained.  Aretaeus  has  gained  considerable  fame, 
says  Puschmann,  from  his  description  of  the  ''Syriac 
ulcer,"  the  picture  of  which  he  draws  agreeing  perfectly 
with  what  is  known  to-day  as  pharyngeal  diphtheria.  In 
various  places  throughout  his  writings  he  displays  a 
thorough  knowledge  of  normal  anatomy — as,  for  example, 
when  he  describes  the  ramifications  of  the  vena  portae  and 
gall-ducts  of  the  liver.  He  was  also  well  informed  in 
matters  belonging  to  the  domain  of  pathology,  for  he  gives 

2  Boerhaave,  the  famous  clinician  of  Leyden,  Holland  (eighteenth  century), 
was  instrumental  in  having  an  excellent  Latin  translation  made  of  this  work; 
and  in  1858  a  German  translation  by  A.  Mann  was  published  in  Halle. 


HISTORY  OF  METHODISM  AT  ROME        145 

admirable  descriptions  of  many  of  the  diseases — for 
example,  pleurisy  with  empyema,  pneumonia,  pulmonary 
consumption,  cerebral  apoplexy,  paraplegia,  tetanus, 
epilepsy,  diabetes  mellitus,  gout,  etc.  From  the  character 
of  these  descriptions  one  is  strongly  tempted  to  believe 
that  he  must  have  made  a  certain  number  of  postmortem 
examinations. 

According  to  Neuburger,  Aretaeus  enters  very  fully  into 
details  when  he  discusses  the  subject  of  diagnosis;  his 
statements  in  one  place  warranting  the  belief  that  he  even 
auscultated  the  heart.  His  methods  of  treatment  were 
based  largely  upon  his  own  experience  and  were  generally 
of  a  simple  character.  He  attached  great  importance,  for 
example,  to  a  very  careful  regulation  of  the  diet,  muscular 
exercise,  massage,  etc.,  and  his  employment  of  remedies 
was  confined  to  a  very  small  number  of  such  drugs  as  exert 
a  mild  action.  When  the  case,  however,  was  of  such  a 
character  as  to  call  for  more  vigorous  interference,  he  did 
not  hesitate  to  resort  to  the  use  of  opium,  emetics, 
cathartics,  venesection,  blistering,  the  red-hot  cautery 
iron,  etc. 

Rufus,  a  native  of  Ephesus,  a  city  of  Asia  Minor,  about 
thirty-five  miles  from  Smyrna,  is  reckoned  by  most  authori- 
ties among  the  Eclectics;  in  other  words,  he  was  an 
independent,  or  one  who  adopted  from  the  teachings  of 
the  different  sects  such  doctrines  as  met  with  his  approval, 
but  who,  at  the  same  time,  did  not  care  to  pose  as  the 
disciple  of  any  one  of  them.  He  received  his  medical 
training  at  Alexandria,  but  it  is  not  known  where  he 
practiced  his  profession.  Almost  no  details  concerning  his 
life  or  his  professional  career  have  come  down  to  our  time. 
It  is  simply  known  that  he  flourished  during  the  reign  of 
the  Emperor  Trajan  (98-117  A.  D.).  Ebn  Ali,  an  Arabian 
physician  and  author,  says  that  he  was  the  leading  medical 
authority  of  his  time  and  that  his  works  were  highly 
esteemed  by  Galen.  His  treatise  on  anatomy  (entitled 
**The  Names  of  the  Different  Parts  of  the  Human  Body"), 
which  is  one  of  the  few  that  have  escaped  destruction,  is 
described  as  a  treatise  which  was  written  for  students,  and 


146  GROWTH  OF  MEDICINE 

which  possesses  great  value  for  the  history  of  anatomical 
nomenclature.  The  same  authority  says  that  Eufus  was 
the  first  to  describe  the  chiasma,  that  he  came  very  near 
establishing  the  existence  of  two  different  kinds  of  nerves — 
motor  and  sensory — and  that  he  attributed  the  control  of 
all  bodily  functions  to  the  nervous  system.  He  also  states 
that  he  was  one  of  the  first  to  furnish  a  description  of  the 
oriental  bubonic  plague.  Some  idea  of  Eufus'  style  of 
writing  may  be  gathered  from  the  following  quotations 
which  have  been  taken  from  his  short  treatise  entitled 
**The  Questioning  of  Patients": — ^ 

It  is  necessary  to  question  the  patient,  for  by  so  doing  one  may 
gather  more  exact  information  concerning  the  nature  of  the  malady, 
and  will  then  be  able  to  treat  it  more  intelligently.  In  this  way 
also  one  may  learn  whether  the  patient's  mind  is  in  a  normal  or 
an  excited  state,  and  whether  any  change  has  taken  place  in  his 
physical  strength.  Some  idea  regarding  the  nature  and  seat  of 
the  disease  is  usually  obtained  from  such  questioning.  If,  for 
example,  the  patient  answers  clearly  and  to  the  point,  and  does 
not  hesitate ;  if  his  memory  does  not  play  him  false ;  if  his  speech 
is  not  thick  or  indistinct;  if,  being  a  well-bred  man,  he  gives  his 
responses  in  a  polite  and  cultivated  manner;  or  if,  in  the  case  of 
a  person  who  is  naturally  timid,  the  answers  reflect  this  timidity, 
then  you  may  feel  confident  that  your  patient 's  mind  is  not  affected. 
But  if,  on  the  other  hand,  you  ask  him  about  one  thing  and  he  gives 
you  a  reply  about  something  entirely  different;  if,  as  he  talks,  he 
appears  to  forget  what  he  was  talking  about ;  if  he  has  a  trembling 
tongue  the  movements  of  which  are  also  uncertain;  and,  finally, 
if  from  a  certain  state  of  mind  he  passes  rapidly  to  one  of  a  totally 
different  character, — all  these  changes  are  evidences  that  the  brain 

is  beginning  to  be  affected If  the  patient  speaks  distinctly 

and  with  a  fairly  strong  voice,  and  is  able  to  tell  his  story 
without  stopping  from  time  to  time  in  order  to  rest,  the 
inference  is  warranted  that  his  physical  strength  is  not  materially 
affected 

The  following  quotation  is  from  his  treatise  on  gout: — 

If  the  patient  complains  that  one  of  his  joints  is  painful,  he 
should  be  asked  whether  or  not  the  part  has  received  a  blow.     If 

3  Translated  from  Oeuvres  de  Bufus  d'£phdse;  Edition  Grecque  et  Fran- 
(jaise,  par  Daremberg  et  Euelle,  Paris,  1879. 


HISTORY  OF  METHODISM  AT  ROME        147 

he  replies  that  it  has  not,  then  (you  may  infer  that  the  pain  is  due 
to  gout  and)  you  should  forthwith  put  him  on  a  suitable  diet, 
order  a  clyster  and  bleed  him  at  a  spot  not  far  (from  the  seat  of 

the  pain) The  withdrawal  of  nourishment  is  ordered  for 

the  purpose  of  arresting  any  further  formation  of  new  blood  and 
thus  preventing  the  joints  from  growing  more  sluggish  in  their 
movements.  The  clyster  is  ordered  because  we  believe  that  it  is 
beneficial  (in  this  condition)  to  evacuate  the  bowels.  The  bleeding 
will  be  found  useful,  but  to  a  less  degree  in  the  loAver  than  in  the 

upper  limbs One  must  be  careful  not  to  assume  that  the 

patient  is  cured  when  he  has  been  entirely  relieved  of  his  pain, 
because  with  the  lapse  of  time  fresh  attacks  are  liable  to  occur; 
this  disease,  like  certain  other  affections,  possesses  a  periodic 
character Therefore  it  is  well,  immediately  after  the  blood- 
letting, to  employ  friction,  to  get  rid  of  the  excess  of  moisture  in 
the  body  by  some  laborious  form  of  exercise,  to  take  such  articles 
of  food  as  are  easily  digested, — in  brief,  to  aim  chiefly  at  reducing 
as  much  as  possible  the  moisture  of  the  body. 

One  cannot  but  feel  a  keen  regret  that  so  few  of  the 
writings  of  this  thoroughly  practical  and  highly  educated 
physician  should  have  come  down  to  our  time.  So  far  as 
I  am  able  to  learn,  Rufus  wrote  no  fewer  than  102 
treatises,  all  of  which,  with  the  exception  of  the  seven 
about  to  be  mentioned  (together  with  a  number  of  frag- 
ments preserved  by  different  writers  of  antiquity)  have 
either  disappeared  or  been  destroyed.  The  titles  of  the 
treatises  which  have  been  preserved  are  as  follows: 
(1)  Diseases  of  the  Kidneys  and  Bladder;  (2)  On  Satyriasis 
and  Gonorrhoea;  (3)  Purgatives;  (4)  The  Names  of  the 
Different  Parts  of  the  Human  Body;  (5)  On  the  Ques- 
tioning of  Patients;  (6)  On  the  Pulse;  (7)  On  Gout. 

A  General  Survey  of  the  Subject  of  Sects  in  Medicine. — 
During  the  sixth  century  B.  C, — that  is,  about  two  hundred 
years  before  the  formation  of  the  more  distinctly  medical 
sects  of  which  mention  was  made  in  Chapter  IX., — 
Pythagoras  of  Samos  and  his  disciples  put  forward 
certain  beliefs  or  doctrines  with  regard  to  the  mode  of 
action  of  some  of  the  functions  or  vital  processes  of  the 
human  body,  and  all  those  who  accepted  these  teachings 
as  affording  a  true  and  satisfactory  explanation  of  the 


148  GROWTH  OF  MEDICINE 

phenomena  in  question  constituted  what  is  generally 
termed  a  school  or  sect.  Some  of  these  individuals  were 
physicians — that  is,  men  who  undertook  to  cure  or  at  least 
to  relieve  those  who  were  ill;  but  probably  the  majority 
were  simply  philosophers,  mere  'Covers  of  wisdom,"  who 
by  studying  problems  of  this  nature  sought  to  satisfy  their 
longing  for  a  more  perfect  knowledge  of  the  truth  respect- 
ing the  various  phenomena  of  life. 

A  few  years  later,  Heraclitus  of  Ephesus,  who,  like 
Pythagoras,  was  both  a  philosopher  and  a  practicing 
physician,  taught  the  doctrine  that  all  things  owe  their 
origin  to  fire.  One  is  not  at  all  surprised  to  learn  that 
he  had  relatively  few  followers,  for  history  tells  us  that 
he  was  both  a  misanthrope  and  a  slanderer  of  the  medical 
profession,  as  shown  by  the  following  saying  which  is 
attributed  to  him:  ''Next  to  physicians  the  grammarians 
are  the  biggest  fools  in  the  world." 

Hippocrates  attached  much  importance  to  the  value  of 
experience  and  to  the  necessity  of  studying  disease  at  the 
bedside;  at  the  same  time  he  upheld  what  is  commonly 
known  by  the  name  of  humoral  pathology — a  doctrine  which 
refers  all  maladies  to  some  abnormal  change  in  the  humors 
or  fluid  portions  of  the  body.  His  writings  also  show  that 
he  made  full  use  of  the  reasoning  power.  The  followers 
of  this  great  physician  did  not  form  a  sect  in  the  ordinary 
sense  of  the  term ;  they  were  his  adherents  simply  because 
he  was  an  able  diagnostician,  a  successful  teacher,  an 
excellent  therapeutist,  a  skilful  surgeon,  a  man  of  very 
high  moral  character, — in  short,  a  great  physician.  Every 
sect  which  developed  in  the  centuries  following  his  death 
contained  a  goodly  proportion  of  Hippocratists. 

Nearly  two  centuries  after  the  active  period  of  the 
professional  life  of  Hippocrates,  Erasistratus  and  Hero- 
philus  gathered  about  themselves  in  Alexandria  (about 
280  B.  C.)  large  groups  of  followers,  who  held  for  their 
respective  teachers  a  degree  of  esteem  which  amounted, 
according  to  Galen,  almost  to  veneration.  As  there  was 
little  or  no  antagonism  or  lack  of  harmony  between  the 
doctrines  taught  by  these  physicians,  the  two  groups  can- 


HISTORY  OF  METHODISM  AT  ROME        149 

not  properly  be  classified  among  the  sects.  In  fact,  it  would 
be  more  correct  to  say  that  Erasistratus  and  Herophilus 
contributed  facts  of  permanent  value  to  our  stock  of 
knowledge  rather  than  doctrines  which  might  prove  highly 
popular  for  a  few  scores  of  years,  but  which  would  prob- 
ably in  due  course  of  time  be  set  aside  as  no  longer  of  value. 

The  four  most  characteristic  types  of  sects  in  medicine 
were  the  following:  the  Dogmatists — or  Rationalists,  as 
Daremberg  calls  them  in  one  place ;  their  great  rivals,  the 
Empirics;  the  Methodists;  and  the  Eclectics.  The  oldest 
sect,  the  Dogmatists,  did  not  come  into  prominence  until 
after  the  medical  schools  at  Alexandria  had  already  been 
in  operation  for  a  long  time.  The  development  of  the  rival 
sect  of  the  Empirics  at  this  late  period  brought  with  it 
endless  discussions  regarding  the  merits  of  their  respective 
teachings,  and  thus  both  of  them  gained  a  degree  of  promi- 
nence which  seems  to  us  moderns  to  have  been  out  of  all 
proportion  to  the  importance  of  the  subject-matters  dis- 
cussed. The  Dogmatists,  says  one  writer,  insisted  that  it 
is  just  as  necessary  to  be  acquainted  with  the  ''hidden 
causes ' '  of  disease  as  with  those  which  are  plainly  recogni- 
zable, and  that  it  is  only  by  aid  of  the  reasoning  power 
that  we  gain  some  knowledge  of  this  class  of  causes.  They 
claimed  that,  while  a  knowledge  of  anatomy  is  of  very 
great  service  to  the  surgeon,  it  usually  renders  this  service 
through  the  aid  of  the  reasoning  power;  as  when,  in  the 
performance  of  a  lithotomy,  the  operator  selects  the  fleshy 
{i.e.,  vascular)  neck  of  the  bladder  as  the  spot  in  which  to 
make  the  opening  with  the  knife,  in  preference  to  the  base 
of  the  organ,  which  is  chiefly  membranous  in  structure  and 
therefore  less  likely  to  heal  solidly. 

The  plausible  but  rather  shallow  response  made  by  the 
Empirics  to  the  arguments  advanced  by  their  rivals  con- 
sisted in  quoting  certain  maxims,  as,  for  example :  *  *  The 
farmer  and  the  helmsman  do  not  acquire  knowledge  of 
their  respective  occupations  from  discussions,  but  from 
actual  practice";  **It  is  not  of  vital  importance  to  know 
what  are  the  causes  of  the  different  diseases,  but  what 


150  GROWTH  OF  MEDICINE 

remedies  are  competent  to  cure  them";  and  "Diseases  are 
not  cured  by  eloquence,  but  by  remedial  agents," 

Among  the  comments  made  by  Celsus  with  regard  to 
the  differences  which  distinguished  the  Dogmatists  from 
the  Empirics  we  find  the  following  statement:  *'The  two 
sects  employed  the  same  remedies  and  pursued  very  much 
the  same  course  of  treatment,  but  their  reasonings  about 
such  matters  were  different." 

Modern  physicians  will,  at  first  thought,  be  disposed  to 
wonder  how  men  as  clever  as  many  of  these  physicians 
were  could  have  split  up  into  separate  and  more  or  less 
antagonistic  sects  because  of  such  apparently  trivial 
differences  of  opinion.  It  must  be  remembered,  however, 
that  these  men  were  groping  in  comparative  darkness 
whenever  they  tried  to  advance  their  knowledge  of  path- 
ology, and  that  in  this  imperfect  light  many  things  seemed 
of  much  greater  importance  than  they  appeared  to  be  in 
the  brighter  light  of  later  centuries.  It  is  only  fair,  there- 
fore, to  withhold  criticism  and  to  ask  ourselves  whether 
this  strong  desire  on  the  part  of  those  men  to  advance 
their  knowledge  of  pathology — a  desire  which  manifested 
itself  in  the  formation  of  sects — was  not  in  reality  an 
evidence  of  the  great  vitality  of  Greek  medicine  on  Eoman 
soil  in  those  early  centuries. 

The  remarks  made  above  with  regard  to  the  Dogmatists 
and  the  Empirics  apply  in  a  general  manner  to  the  sects 
known  as  the  Methodists  and  the  Eclectics,  a  sufficiently 
full  account  of  which  has  been  given  in  the  preceding 
chapter.* 

4  The  term  '  *  dogmatists ' '  is  also  employed  by  some  authorities  to  designate 
those  physicians  who  laid  great  stress  upon  the  importance  of  following  the 
teachings  of  Hippocrates  and  Galen. 


CHAPTER  XIV 

WELL-KNOWN     MEDICAL     AUTHORS     OF     THE 
EARLY  CENTURIES  OF  THE  CHRISTIAN  ERA 

There  were  four  men  who  were  not  especially  identified 
with  any  of  the  sects  described  in  the  preceding  chapters, 
and  yet  who  occupied,  as  authors  of  medical  treatises,  very 
prominent  places  in  the  history  of  medicine  of  the  period 
or  epoch  which  we  have  just  been  considering.  They  are 
Celsus,  Scribonius  Largus,  Pliny  the  Elder  and  Dioscori- 
des.  These  men  lived  during  the  first  and  second  centuries 
A.  D.  and  they  therefore  all  belong  strictly  to  the  period 
which  is  designated  in  our  scheme  as  the  fourth  epoch. 
I  shall  give  here  brief  sketches  of  all  of  these  writers  and 
of  their  works.  While  Caelius  Aurelianus,  another  impor- 
tant medical  author,  belonged  to  a  much  later  period,  I  shall, 
for  reasons  of  convenience,  describe  in  the  same  chapter 
with  the  others  the  part  which  he  played  in  the  evolution 
of  medicine. 

Aulus  Cornelius  Celsus,  called  by  some  the  Latin  Hip- 
pocrates and  by  others  the  Cicero  of  physicians  because 
of  the  correctness  and  elegance  of  his  Latin  and  the  clear 
manner  in  which  he  puts  his  thoughts  into  words,  flour- 
ished during  the  reign  of  the  Emperor  Augustus  (27  B.  C- 
14  A.  D. ) .  The  date  and  place  of  his  birth  are  not  known, 
but  it  is  generally  believed  that  he  was  born  and  received 
his  education  at  Rome.  The  great  work  which  he  wrote 
and  upon  which  he  must  have  been  engaged  the  larger  part 
of  his  lifetime  was  a  sort  of  cyclopaedia,  which  bore  the 
title  ^^Artium  libri,'*  and  in  which  each  department  of 
knowledge  was  represented  by  a  separate  treatise.  It  is 
said  that  five  books  were  devoted  to  agriculture,  seven  to 
rhetoric,  eight  to  medicine,  etc. ;  but  all  of  these  treatises. 


152  GROWTH  OF  MEDICINE 

excepting  those  relating  to  the  latter  science,  have  been 
lost  or  destroyed.  It  is  not  certainly  known  to  which  of 
the  professions  Celsus  belonged,  but  the  very  skilful  and 
judicious  manner  in  which  he  has  culled  all  that  is  best  from 
the  medical  treatises  published  before  his  time,  the  remark- 
able knowledge  of  technical  details  which  he  displays  in 
every  part  of  his  own  work,  and  the  fine  tone  of  medical 
thought  which  pervades  these  eight  books,  almost  compel 
the  conclusion  that  the  author  was  a  very  clever  clinician, 
although  probably  not  a  physician  who  practiced  for  a 
money  reward.  In  no  other  published  treatise  is  a  more 
perfect  picture  of  the  medical  practice  of  antiquity  to  be 
found  than  that  which  Celsus  gives  us  in  his  work  ^^De  arte 
medica  libri  octo." 

It  is  not  an  easy  matter  to  select,  from  a  treatise  of 
several  hundred  pages  in  length,  one  or  two  passages  of 
such  a  character  that  they  may  be  accepted  as  fairly  repre- 
senting the  author's  manner  of  dealing  with  medical  and 
surgical  questions  of  practical  interest.  The  two  given 
below  are  translations  from  Vedrenes'  version  (Paris, 
1876),  and  they  deal,  the  one  with  venesection  and  the  other 
with  the  proper  manner  of  arresting  hemorrhage  from  a 
wound.  Both  the  passages  quoted  represent  only  frag- 
ments, as  sufficient  space  for  more  extensive  extracts  is  not 
available. 

Book  II.,  Chapter  X. — Bloodletting  from  a  Vein. — Incising  a 
vein  for  the  purpose  of  drawing  blood  from  it,  is  not  a  new  pro- 
cedure ;  but  it  is  certainly  a  new  thing  to  resort  to  bloodletting  in 
almost  all  diseases.  Again,  it  is  an  ancient  custom  to  employ 
bloodletting  in  young  subjects  and  in  women  who  are  not  preg- 
nant, but  it  is  a  new  thing  to  perform  this  operation  on  infants 
and  aged  individuals,  and  on  women  approaching  the  period  of 
confinement.  It  was  the  idea  of  the  ancients  that  persons  at  the 
two  extremes  of  life  were  not  able  to  support  this  sort  of  treatment, 
and  they  were  convinced  that  a  pregnant  woman,  if  subjected  to 
the  operation  of  bloodletting,  would  almost  surely  be  confined 
before  the  completion  of  her  time.  Since  then,  however,  experience 
has  shown  that  there  is  no  fixed  rule  about  this  matter,  and  that 
a  physician  should  preferably  regulate  his  course  in  accordance 
with  observations  of  a  different  nature.     The  determining  factor, 


EARLY  MEDICAL  AUTHORS  153 

for  instance,  is  neither  the  age  nor  the  pregnant  state  of  the  patient, 
but  rather  the  degree  of  physical  strength.  In  the  case  of  a  youth 
who  is  feeble,  or  of  a  delicate  woman  (aside  from  the  question  of 
pregnancy),  it  would  be  wrong  to  draw  blood,  for  it  would  be 
robbing  them  of  what  little  strength  they  possessed.  But,  in  the 
case  of  a  vigorous  child,  a  robust  old  man,  or  a  pregnant  woman 
who  is  in  good  health,  one  need  not  hesitate  to  resort  to  this  pro- 
cedure. Nevertheless,  there  may  arise,  in  connection  with  the 
operation  of  venesection,  a  number  of  questions  which  are  quite 
likely  to  puzzle  an  inexperienced  physician  and  perhaps  lead  him 
into  error.  For  example,  infants  and  old  people  possess  as  a  rule 
diminished  vigor,  and  the  woman  who  is  about  to  be  confined  needs 
all  her  strength  for  the  period  following  delivery,  both  for  herself 
and  for  the  nourishing  of  the  child.  But  the  mere  fact  that  one 
must  give  some  thought  to  questions  of  this  nature  and  must  exer- 
cise prudence  does  not  justify  the  immediate  rejection  of  a  method 
of  treatment  like  that  of  venesection.  For  is  it  not  the  very  essence 
of  our  art,  not  merely  to  consider  the  factors  of  age  and  the 
pregnant  state,  but  also  to  form  an  estimate  of  that  other  and 
more  important  factor,  viz.,  the  patient 's  strength, — be  that  patient 
an  infant,  an  aged  person,  or  a  woman  advanced  in  pregnancy, — 
and  then  to  decide  whether  it  is,  or  is  not,  great  enough  to  bear 
the  loss  of  blood?  In  deciding  a  question  of  this  kind  it  will  be 
necessary  to  distinguish  between  real  vigor  and  obesity,  between 
thinness  and  feebleness,  etc. 

Venesection  is  an  easy  operation  for  a  physician  who  has  already 
familiarized  himself  with  the  manner  of  performing  it,  but  for  one 
who  is  ignorant  of  these  details  it  may  prove  very  difficult.  It  is 
necessary,  for  example,  to  bear  in  mind  that  the  artery  and  vein 
are  united  and  that  they  are  accompanied  by  nerves ;  and,  further, 
that  the  injuring  of  the  latter  will  induce  spasms  and  violent  pains. 
On  the  other  hand,  it  must  also  not  be  forgotten  that  an  artery 
once  opened  has  no  disposition  to  close,  nor  does  it  heal,  and  that 
sometimes  the  blood  escapes  in  an  impetuous  manner.  If,  per- 
chance, the  vein  is  cut  transversely,  the  edges  of  the  opening  con- 
tract and  no  more  blood  escapes.  Again,  if  the  scalpel  is  plunged 
into  the  parts  timidly,  the  skin  alone  will  be  divided  and  the  vein 
will  not  be  opened.  In  some  cases  this  vessel  is  so  hidden  from 
sight  that  the  physician  may  experience  difficulty  in  bringing  it 
into  view.  Thus  it  will  be  seen  that  there  are  several  circumstances 
which  may  render  this  operation  difficult  for  an  ignorant  or  inex- 


154  GROWTH  OF  MEDICINE 

perienced  physician.  The  vein  should  be  incised  in  a  longitudinal 
direction,  midway  between  its  two  sides.  The  moment  the  blood 
gushes  from  the  opening  its  color  and  general  appearance  should 
be  carefully  noted,  etc. 

Book  v..  Chapter  XXYI. — The  Proper  Manner  of  Arresting 
Hemorrhage  from  a  Wound. — If  there  is  fear  that  there  may  be 
bleeding,  one  should  fill  the  wound  with  dry  lint,  place  over  it  a 
sponge  wrung  out  of  cold  water,  and  press  upon  it  with  the  hand. 
If  the  bleeding  still  continues,  it  is  advisable  to  change  the  stuffing 
of  lint  somewhat  frequently;  and,  if  this  step  proves  ineffective, 
then  lint  moistened  with  vinegar  may  be  tried,  for  this  liquid 
acts  energetically  in  arresting  hemorrhage.  Some  physicians,  in- 
deed, actually  pour  it  into  the  wound.  There  is  a  strong  objection, 
however,  to  the  use  of  an  agent  which,  like  vinegar,  arrests  the 
bleeding  too  completely — viz.,  that  it  is  apt  to  set  up  afterwards 
an  intense  inflammation  of  the  parts.  The  same  reasoning  applies 
with  even  greater  force  to  the  employment  of  corrosives  and  caus- 
tics, which  produce  an  eschar.  Despite  the  effectiveness  of  most  of 
these  in  arresting  hemorrhage,  their  use  should  be  discouraged. 

Finally,  if  the  bleeding  continues  it  will  be  necessary  to 

grasp  the  vessel  from  which  the  blood  is  escaping,  to  ligature  it 
in  two  places  close  to  the  wound,  and  then  to  divide  the  vessel 
between  the  two  ligatures,  in  order  that  it  may  retract  (both  of 
the  new  orifices  having  already  been  closed  by  the  ligatures).  If 
the  circumstances  are  such  that  the  plan  just  recommended  can- 
not be  carried  out,  it  will  then  be  advisable  to  apply  the  red-hot 
cautery  to  the  bleeding  vessel.  When  a  rather  free  hemorrhage 
occurs  at  a  part  of  the  body  where  there  are  no  nerve  trunks  and 
no  muscles, — as  on  the  forehead  or  at  the  top  of  the  head, — the 
simplest  plan  is  to  apply  a  cup  at  some  little  distance  from  the 
source  of  the  bleeding  and  thus  divert  the  current  of  the  blood 
from  the  spot  affected. 

And  to  these  two  longer  extracts  may  be  added  a  third : — 

From  these  considerations  the  inference  is  warranted  that  a 
physician  cannot  possibly  give  proper  attention  to  a  large  number 
of  patients.     (Book  III.,  Chapter  IV.) 

Celsus'  treatise  was  ignored  by  physicians  for  many 
centuries,  but  it  was  considered  by  the  monks,  in  the  Mid- 
dle Ages,  a  valuable  guide  in  the  treatment  of  disease ;  and 
it  was  probably  owing  to  this  circumstance,  says  Vedrenes, 


EARLY  MEDICAL  AUTHORS  155 

that  the  book  did  not  altogether  disappear.  It  was  not 
until  the  year  1443  that  Thomas  de  Sazanne,  afterward 
Pope  Nicholas  V.,  discovered  a  copy  of  the  work  in  the 
church  of  Saint  Ambrosius,  at  Milan,  but  it  was  only  in 
1478  that  the  book  was  printed  for  the  first  time  (at  Flor- 
ence). Then,  as  if  to  make  up  for  the  long  neglect  to  which 
it  had  been  subjected,  no  fewer  than  sixty  Latin  editions 
were  issued  during  the  two  succeeding  centuries;  and,  in 
addition,  it  was  eventually  translated  into  every  modern 
European  language. 

Scribonius  Largus,  a  Roman  physician  who  lived  dur- 
ing the  reigns  of  Tiberius  and  Claudius  (14-54  A.  D.),  owes 
his  celebrity  to  the  fact  that  he  wrote  and  published  (in  47 
A.  D.)  a  book  containing  a  collection  of  the  best  medical 
formulae  and  popular  recipes  known  at  that  time.  He  ap- 
pears to  have  had  a  large  private  practice  and  to  have 
spent  a  considerable  portion  of  his  professional  life  in  the 
service  of  the  army.  He  accompanied  the  Emperor 
Claudius,  for  example,  in  his  campaign  against  Britain 
(43  A.  D.),  and  the  book  which  he  wrote,  and  which  has  just 
been  mentioned,  was  dedicated  by  him  to  that  emperor. 
According  to  Neuburger,  Scribonius  is  to  be  credited  with 
having  been  the  first  to  describe  correctly  the  proper  manner 
of  obtaining  the  drug  known  as  opium,  and  also  the  first 
to  recommend,  in  the  treatment  of  severe  headaches,  the 
employment  of  electric  shocks  as  communicated  by  the  fish 
called  the  ** electric  ray." 

Medical  practice  at  that  period,  says  Le  Clerc,  was 
divided  among  three  kinds  of  practitioners — those  who 
treated  their  cases  exclusively  by  dietetic  measures,  those 
who  effected  cures  by  surgical  means,  and  those  who  took 
charge  only  of  such  patients  as  required  chiefly  the  employ- 
ment of  external  remedies.  But  Scribonius  Largus  insists 
that  such  a  division  was  more  theoretical  than  real,  as 
no  one  of  these  classes  could  get  along  without  the  co- 
operation of  the  others. 

C.  Plinius  Secundus,  commonly  called  Pliny  the  Elder, 
was  born  near  the  beginning  of  the  first  century  of  the 
Christian  era,  either  at  Verona  or  at  Como  in  the  north 


156  GROWTH  OF  MEDICINE 

of  Italy,  and  settled  in  Eome  at  an  early  period  of  his  life. 
At  the  beginning  of  his  career  he  served  for  some  time  in 
the  army  in  Germany,  and  upon  his  return  to  Eome  prac- 
ticed as  a  pleader.  Subsequently  he  held  various  official 
positions  which  gave  him  the  opportunity  of  visiting  other 
countries  of  Europe.  He  perished  at  Stabiae  (near  the 
modern  Castellamare,  on  the  Gulf  of  Naples)  in  79  A.  D., 
at  the  age  of  fifty-six  years,  while  watching  the  eruption  of 
Vesuvius,  which  overwhelmed  Herculaneum  and  Pompeii. 
He  was  in  command  of  the  Roman  fleet  at  the  time. 

Pliny  was  indefatigable  as  a  writer  and  as  a  gatherer 
of  knowledge  of  all  sorts,  and  he  and  Celsus  are  well  named 
the  Encyclopaedists.  He  is  said  to  have  written  twenty 
books  on  the  war  with  the  Germans,  an  unknown  number 
on  rhetoric  and  grammar,  and  thirty-seven  on  natural  his- 
tory. The  latter  books  alone  have  come  down  to  our  time. 
Pliny's  nephew,  who  is  known  as  Pliny  the  Younger,  and 
who  edited  the  great  work  of  his  uncle  on  natural  history, 
furnishes  us,  in  a  letter  addressed  to  the  historian  Taci- 
tus, with  some  interesting  details  regarding  the  elder 
Pliny's  manner  of  life.  It  appears  from  this  account,  that 
the  latter  read  almost  incessantly.  During  his  meals  and 
while  he  was  taking  his  bath,  an  attendant  read  aloud  to 
him.  He  also  took  his  books  with  him  on  his  travels  and 
was  always  accompanied  by  a  person  who  could  write  rap- 
idly under  dictation.  He  continued  this  practice  upon  his 
return  to  Rome  and  dictated  to  his  amanuensis  even  while 
he  was  being  carried  about  in  a  sedan  chair.  Books  20- 
27  of  his  great  work  on  natural  history  are  devoted  to  the 
subject  of  remedial  agents  belonging  to  the  vegetable  king- 
dom, books  28-32  deal  with  those  which  belong  to  the  ani- 
mal kingdom,  and  books  33-37  treat  of  mineralogy  with 
special  reference  to  medicine,  painting  and  sculpture. 
Pliny  was  a  compiler  and  not  an  original  investigator. 
Some  idea  of  the  popularity  of  his  treatise  on  natural  his- 
tory may  be  gathered  from  the  fact  that  it  was  the  second 
book  to  be  printed  after  the  invention  of  printing,  the  Bible 
being  the  first.  Another  interesting  fact  connected  with 
Pliny's  treatise  is  mentioned  by  Neuburger,  viz.,  that  the 


EARLY  MEDICAL  AUTHORS  157 

use  of  hyoscyamus  and  belladonna  as  agents  capable  of 
dilating  the  pupils,  owed  its  origin  to  the  discovery  (by  C. 
Himly,  in  1800)  of  a  place  in  the  text  (Book  XXV.,  92) 
where  it  is  stated  that  the  juice  of  the  plant  Anagallis  was 
rubbed  into  the  eyes  before  the  operation  for  cataract  was 
undertaken. 

According  to  Pliny  (Book  XXXL,  Chapter  VI.),  the 
ancients  employed  mineral  waters  extensively  in  the  form 
of  baths,  and  they  also  occasionally  used  them  as  internal 
remedies.  Galen,  too,  mentions  the  fact  that  these  waters 
were  in  demand  in  the  spring  or  autumn  for  purgative  pur- 
poses. 

In  Book  XXXIX.,  8,  3,  Pliny — as  quoted  by  Vedrenes — 
makes  the  following  remarks : — 

Very  few  Romans  have  shown  an  active  interest  in  medical  affairs, 
and  those  few  speedily  found  it  necessary  to  pass  themselves  off  as 
Greeks.  For  it  is  a  well-known  fact  that  those  physicians  who, 
without  being  able  to  speak  Greek,  attempted  to  build  up  a  prac- 
tice in  Rome,  failed  to  gain  the  confidence  of  their  patients,  even 

of  those  who  were  not  at  all  familiar  with  that  language 

When  one's  health  is  the  question  at  issue  the  readiness  to  place 
confidence  in  a  medical  adviser  is  apt  to  diminish  in  proportion 
as  one's  knowledge  of  the  man  increases.  Indeed,  medicine  is  the 
only  art  in  which  one  is  quite  ready  at  first  to  put  faith  in  almost 
anybody  who  calls  himself  a  physician,  and  that  too,  despite  the 
acknowledged  fact  that  in  no  other  circumstances  of  life  is  an 
imposture  more  fraught  with  danger. 

English  versions  of  Pliny's  Natural  History  and  of 
Pliny  the  Younger 's  Letters  have  been  published  in  what 
is  known  as  Bohn's  Libraries. 

Pedanius  Dioscorides,  a  native  of  Anazarba,  a  small 
Greek  town  near  Tarsus  in  Cilicia,  lived  about  the  middle 
of  the  first  century  A.  D.  (during  the  reigns  of  Nero  and 
Vespasian).  From  his  earliest  youth  he  took  a  great  in- 
terest in  botany,  and,  after  reaching  manhood,  traveled 
extensively  in  the  wake  of  different  Roman  armies,  for 
the  sole  purpose  of  studying  by  direct  observation  the 
plants  of  different  countries  and  of  verifying  the  medicinal 
virtues  which  each  one  was  reputed  to  possess.     In  this 


158  GROWTH  OF  MEDICINE 

way  lie  visited,  in  turn,  Greece,  Italy,  Asia  Minor  and  per- 
haps also  the  southern  portion  of  France  (the  Narbonaise). 
He  collected  great  quantities  of  specimens  of  every  kind 
of  drug — animal  and  mineral  substances  as  well  as  objects 
belonging  to  the  vegetable  kingdom;  and,  wherever  it  was 
possible  to  do  so,  he  wrote  memoranda  of  the  traditions 
of  the  natives  with  regard  to  the  uses  and  medicinal  effects 
of  these  different  drugs.  After  he  had  completed  all  these 
researches  and  had  gathered  together  all  this  vast  mass  of 
materials,  he  wrote  his  famous  treatise  on  materia  med- 
ica — 'Hhe  most  complete,  the  best  considered,  and  the 
most  useful  work  of  its  kind  to  be  found  anywhere  to-day." 
(Galen.)  It  is  from  this  treatise,  therefore,  says  Dezei- 
meris,  that  one  can  derive  the  most  satisfactory  idea  of 
the  early  Greek  materia  medica ;  but  at  the  same  time,  he 
adds,  it  is  not  a  book  in  which  will  be  found  a  detailed 
account  of  the  manner  in  which  the  practitioners  of  that 
period  employed  the  remedies  which  he  describes.  The 
same  authority  calls  attention  to  the  great  difficulty  which 
modern  physicians  often  experience  in  their  attempts  to 
identify  the  drugs  which  Dioscorides  describes.  Le  Clerc 
calls  attention  to  the  fact  that  the  physicians  who  were 
contemporaries  of  Dioscorides  were  not  in  the  habit  of 
employing  either  iron  or  antimony  (called  by  them  stibium) 
internally.  Apparently  they  had  not  yet  learned  that  these 
substances  possess  properties  which  exert  a  curative  action 
in  certain  diseases.  On  the  other  hand,  he  mentions  the 
manner  of  extracting  quicksilver,  by  chemical  means,  from 
cinnabar  [red  sulphide  of  mercury],  the  steps  required 
for  preparing  acetate  of  lead,  and  the  proper  way  of  mak- 
ing lime  water. 

The  work  to  which  reference  has  been  made  above  was 
published  by  Dioscorides  about  the  year  77  A.  D.  It  is 
the  earliest  pharmacological  treatise  that  has  come  down 
to  our  time,  and  for  many  succeeding  centuries  it  served 
as  the  authoritative  guide  in  all  questions  relating  to  drugs. 
The  first  printed  edition  of  the  Greek  original  appeared  in 
Venice  in  1499,  but  a  still  earlier  Latin  version  was  issued 
in  1478.    According  to  Pagel  the  best  edition  (in  Latin  and 


EARLY  MEDICAL  AUTHORS  159 

fully  illustrated)  is  that  of  Pietro  Andrea  Mattioli,  which 
was  printed  in  Venice  in  1554.  Neuburger  commends 
highly  the  German  version  by  J.  Berendes.  (Stuttgart, 
1902.) 

Of  Caelius  Aurelianus  we  possess  no  biographical  de- 
tails beyond  the  facts  that  he  was  a  native  of  Sicca  in 
Numidia,  Africa,  and  that  he  lived  toward  the  end  of  the 
fourth  or  during  the  first  part  of  the  fifth  century  of  the 
present  era.  He  was  the  author  of  several  works,  all  but 
one  of  which,  however,  have  been  lost.  The  single  treatise 
which  has  come  down  to  our  time  treats  of  acute  and 
chronic  diseases,  and  is  spoken  of  by  Daremberg  as  being 
virtually  a  translation  of  one  of  the  lost  writings  of  Sora- 
nus.  This  book,  says  Haeser  in  his  History  of  Medicine, 
is  the  most  important  source  from  which  our  knowledge 
of  Methodism  is  derived;  and  Neuburger  not  only  agrees 
with  this  statement,  but  adds  that  the  treatise  of  Caelius 
Aurelianus  played  a  most  important  part,  toward  the  end 
of  the  Middle  Ages,  in  the  evolution  of  medicine.  Up  to 
the  present  time  no  translation  of  this  work  into  any  mod- 
ern language  has  been  published,  but  Neuburger  furnishes 
a  very  full  analysis  of  its  important  parts.  In  two  places, 
as  appears  from  this  analysis,  Caelius  Aurelianus  men- 
tions— among  the  signs  and  symptoms  of  certain  affections 
of  the  respiratory  apparatus — phenomena  which  show 
beyond  a  doubt  that  he  (or  Soranus)  was  familiar  with 
auscultation  of  the  chest.  The  words  which  he  uses  are 
these : — 

''Stridor  vel  sonitus  interius  resonans  aut  sihilans  in  ea 
parte  quae  patitur,"  and  ''  sihilatus  vehemens  atque  asper 
in  ultimo  etiam  pectoris  resonans  stridor." 


CHAPTER  XV 

CLAUDIUS  GALEN 

During  the  centuries  immediately  preceding  the  Chris- 
tian era,  Greek  medicine  was  represented  by  a  collection 
of  treatises  which  had  been  written  by  Hippocrates  and  his 
followers  on  anatomical,  physiological,  pathological,  thera- 
peutical and  ethical  subjects,  and  which  constituted  a  fairly 
complete  but  not  always  easily  intelligible  system.  As 
time  went  on,  however,  and  especially  as  new  and  useful 
facts  were  constantly  being  added  to  the  existing  stock  of 
medical  knowledge,  the  more  thoughtful  physicians  began 
to  feel  that  the  system,  which  up  to  that  day  had  proved 
acceptable,  needed  to  be  perfected  in  a  number  of  respects ; 
and  accordingly,  as  a  result  of  this  feeling  of  dissatisfac- 
tion, and  also  as  an  expression  of  the  prevailing  desire 
for  a  more  perfect  knowledge  of  the  truth,  there  developed, 
as  has  been  stated  in  the  preceding  chapters,  a  number  of 
different  medical  sects.  When  Galen  first  appeared  in  the 
field  as  a  physician  of  unusual  promise,  these  various  sects 
were  all  still  in  a  thriving  condition.  The  Methodists,  in 
particular,  were  very  popular.  Galen  did  not  favor  any 
special  sect,  but  in  his  writings  he  made  it  manifest  that 
he  attached  more  importance  to  the  teachings  of  Hip- 
pocrates than  to  those  of  any  other  author.  ''It  was  Hip- 
pocrates," he  said,  ''who  laid  the  real  foundations  of  the 
science  of  medicine."  It  is  therefore  not  surprising  that 
Galen  should  have  devoted  so  much  time  to  the  writing  of 
elaborate  commentaries  on  the  works  of  Hippocrates.  The 
service  which  he  thus  rendered  to  medicine,  says  Darem- 
berg,  was  of  very  great  value.  But  Galen,  notwithstanding 
his  great  admiration  for  Hippocrates,  did  not  hesitate  to 


^ 


CLAUDIUS  GALEN  161 

criticise  a  number  of  his  teachings,  and  especially  those 
which,  as  he  believed,  were  not  stated  with  sufficient  clear- 
ness. Valuable  as  was  the  service  rendered  to  medicine  by 
the  writing  of  these  commentaries,  there  still  remained  an 
urgent  need  for  a  service  of  a  different  and  much  more 
difficult  kind,  viz.,  that  of  welding  together  into  a  single 
clearly  written  and  easily  intelligible  system  of  medicine, 
all  that  was  good  in  the  Hippocratic  writings  and  in  the 
disconnected  and  at  times  antagonistic  teachings  of  the 
sects.  To  accomplish  this  successfully  required  the  ser- 
vices of  a  man  endowed  with  mental  gifts  of  a  most  excep- 
tional character — complete  knowledge  of  medicine  in  all 
its  departments,  a  mind  thoroughly  trained  in  philosophy, 
the  power  to  express  his  thoughts  in  simple  language,  and  ijji 

an  independence  and  fairness  of  judgment  which  would 
render  him  indifferent  to  the  petty  interests  of  the  sects. 
Claudius  Galen,  as  subsequent  events  showed,  possessed 
these  very  gifts  in  a  high  degree,  and  he  devoted  the  better 
part  of  his  reasonably  long  lifetime  to  the  accomplishment 
of  this  much-needed  work.  How  greatly  it  was  needed  at 
that  particular  period  of  time,  nobody  then  knew  or  could 
even  suspect.  It  soon  appeared,  however,  that  all  the 
vaunted  civilization  of  the  Graeco-Roman  world — ^much  of 
it  of  the  purest  gold  and  a  great  deal  of  the  basest  alloy — 
was  to  be  swept  so  completely  off  the  face  of  the  earth  that, 
for  thirteen  hundred  or  more  years,  almost  no  thought 
whatever  could  possibly  be  given  to  the  science  and  art  of 
medicine.  Fortunate,  most  fortunate  it  was,  therefore, 
that,  before  this  wave  of  destruction  reached  Rome,  all  the 
best  part  of  Greek  medical  literature — for  such  it  was  in 
truth — had  been  gathered  together  and  carefully  systema- 
tized by  Galen  and  stowed  away  in  the  recesses  and  cham- 
bers of  remotely  situated  monasteries  and  churches  by 
clear-sighted  monks  for  the  benefit  of  later  generations  of 
physicians. 

Brief  Biographical  Sketch. — Claudius  Galen  was  born 
in  Pergamum,  an  important  Greek  city  of  Asia  Minor, 
about  the  year  131  A.  D.,  under  the  reign  of  the  Emperor 
Hadrian.    His  father,  whose  name  was  Nicon,  was  a  man 


*i 


162  GROWTH  OF  MEDICINE 

of  ample  means,  well  informed  in  philosophy,  astronomy 
and  geometry,  and  most  liberal  in  providing  for  the  thor- 
ough education  of  his  son  in  every  branch  of  useful  knowl- 
edge. In  two  or  three  places  in  his  writings  Galen  speaks 
of  his  father  in  terms  of  affection.  On  the  other  hand,  he 
does  not  hesitate  to  state  in  the  plainest  language  possible 
that  his  mother  was  a  veritable  Xanthippe.  In  her  mo- 
ments of  bad  temper  she  would  not  only  shout  and 
scream  in  a  violent  manner,  but  would  sometimes  go  so 
far  as  to  bite  her  serving-maids.  Pergamum,  at  the  time 
of  which  I  am  writing,  offered  unusually  good  opportu- 
nities for  studying  disease.  Its  Asclepieion,  which  was 
built  during  Galen's  boyhood,  had  already  become  one  of 
the  famous  temples  of  Asia  Minor,  and  the  sick  and  maimed 
flocked  to  it  in  large  numbers.  Then,  in  addition,  the  city 
was  well  equipped  with  able  physicians,  who  appear,  ac- 
cording to  Neuburger,  to  have  been  on  very  friendly 
terms  with  the  priests  of  the  temple.  It  was  under  the 
guidance  of  such  men  that  Galen — at  the  early  age  of 
seventeen,  and  after  a  careful  training  in  philosophy, 
mathematics,  etc. — began  the  study  of  medicine.  He  speaks 
with  special  interest  and  respect  of  one  of  his  instructors, 
a  certain  Quintus,  who  had  the  reputation  of  being  an  ex- 
cellent anatomist  and  at  the  same  time  one  of  the  most  dis- 
tinguished practitioners  of  that  day.  Another  anatomist, 
Styrus,  was  also  one  of  Galen's  teachers. 

On  the  death  of  his  father  Galen  left  his  home  and  de- 
voted the  succeeding  nine  years  to  visiting  all  the  differ- 
ent cities  in  which  he  believed  he  might  gain  some  addi- 
tional knowledge  in  medicine  and  surgery.  A  large  part 
of  this  long  period  was  spent  in  Alexandria,  which  still 
retained  much  of  its  importance  as  a  home  of  all  the  sci- 
ences. On  attaining  his  twenty-eighth  year  he  left  that 
city  and  returned  to  Pergamum,  evidently  with  the  pur- 
pose of  establishing  himself  there  in  the  regular  practice 
of  his  profession.  Through  the  influence  of  the  temple  offi- 
cials, and  especially  of  the  High  Priest,  Galen  received  the 
appointment  of  physician  to  the  gladiators,  a  position 
which  he  held  with  credit  for  a  period  of  four  years,  and 


CLAUDIUS  GALEN  163 

which  afforded  him  excellent  opportunities  for  cultivating 
his  knowledge  of  surgery.  It  was  while  he  was  serving 
in  this  capacity  that  he  devised  and  put  into  practice 
a  method  of  saturating  the  dressings  (in  cases  of  severe 
wounds)  with  red  wine,  for  the  purpose  of  preventing  the 
development  of  inflammation  in  the  parts  affected ;  and  the 
success  which  he  thus  obtained  was  so  great  that  not  one 
of  the  gladiators  intrusted  to  his  care  died  from  his 
wounds.  History  does  not  state  the  precise  manner  in 
which  Galen  carried  out  his  method  of  utilizing  wine  in  the 
dressing  of  wounds,  and  we  are  therefore  unable  to  deter- 
mine just  how  much  credit  he  was  entitled  to  receive  for 
this  crude  but  apparently  effective  means  of  securing  local 
antisepsis.  It  is  clear,  however,  that  Galen's  treatment 
could  only  have  been  a  modification  of  a  much  older  method, 
for  Jesus,  in  his  answer  to  a  question  put  to  him  by  a 
lawyer,  said :  * '  But  a  certain  Samaritan,  as  he  journeyed, 
came  where  he  (the  injured  man)  was:  and  when  he  saw 
him,  he  had  compassion  on  him,  and  went  to  him,  and  bound 
up  his  wounds,  pouring  in  oil  and  wine,  and  set  him  on  his 

own  beast, "    (St.  Luke  x.,  33,  34). 

At  the  end  of  four  years  there  broke  out  in  Pergamum  a 
riot  which  rendered  residence  there,  at  least  for  a  certain 
length  of  time,  undesirable.  Accordingly  Galen,  who  was 
now  thirty-two  years  old,  and  who  was  probably  glad  of  an 
excuse  for  leaving  a  place  where  a  physician  of  his  educa- 
tion and  talents  had  so  few  opportunities  for  gaining  dis- 
tinction, decided  to  visit  Rome,  and — if  circumstances  ap- 
peared to  favor  the  plan — to  settle  there.  His  first  impres- 
sions after  arriving  in  that  metropolis  were  favorable  to 
the  plan  of  establishing  himself  there  permanently,  but  at 
the  end  of  a  few  years  he  became  conscious  of  the  growing 
hostility  of  those  practitioners  who  had  been  for  a  longer 
time  than  he  well  established  in  that  city.  This  hostility 
increased  as  he  rose  in  favor  and  esteem  with  people  of 
position  and  influence.  He  had  treated  skilfully  and  with 
success  Eudemus,  a  peripatetic  philosopher  of  great  celeb- 
rity, for  a  quartan  fever.  He  had  also  cured  the  wife  of 
Boethus  (a  patrician  who  belonged  to  the  consular  class) 


164  GROWTH  OF  MEDICINE 

of  a  serious  illness  and  had  received  as  an  expression  of 
appreciation  a  gift  of  four  hundred  pieces  of  gold.  He 
had  won  the  friendship  and  esteem  of  such  men  as  Sergius 
Paulus,  the  Praetor;  of  Barbarus,  the  uncle  of  the  Em- 
peror Lucius;  and  of  Severus,  who  was  at  that  time 
Consul,  but  who  later  became  Emperor.  These  very  in- 
fluential men  took  an  active  interest  in  Galen's  scientific 
work,  having  been  invited  by  him  on  more  than  one  occa- 
sion to  witness  his  dissections  of  apes, — dissections  which 
he  made  for  the  particular  purpose  of  demonstrating  the 
organs  of  respiration  and  of  the  voice.  All  these  facts  soon 
became  known  to  Galen's  rivals  and  probably  helped  to 
fan  the  spark  of  their  envy  into  a  flame;  but  it  is  very 
doubtful  whether  he  was  justified  in  saying  that  the  ill 
feeling  thus  engendered  threatened  to  end  in  some  act  of 
personal  violence,  for  which  reason  he  decided  to  leave 
Rome  and  return  to  Pergamum.  His  secret  manner  of  de- 
parture, without  taking  leave  of  anybody,  and  the  fact 
that  the  Plague  was  just  at  that  time  rapidly  approaching 
Rome,  justify  the  belief,  says  Neuburger,  that  it  was  not 
fear  of  personal  violence  at  the  hands  of  his  jealous  rivals 
that  drove  Galen  away  so  mysteriously  from  the  city  in 
which,  in  the  short  space  of  four  or  five  years,  he  had  won 
so  great  professional  success,  but  an  unwillingness  to  face 
his  duty,  which  was,  to  remain  and  aid  in  the  approaching 
fight  against  the  great  destroyer — the  Plague.  If  Galen 
had  been  a  simple  physician,  one  of  the  great  body  of  med- 
ical practitioners  in  Rome,  no  one  would  be  disposed  to 
question  the  justice  of  the  criticism  which  the  distinguished 
Viennese  historian  makes  of  his  decision  to  abandon  that 
city  at  the  moment  of  her  distress  and  peril.  But,  as  a 
matter  of  fact,  Galen  was  not  a  practitioner  of  medicine 
in  the  full  sense  of  that  term.  He  treated  cases  of  illness 
because  in  no  other  way  would  it  be  possible  for  him  to 
acquire  the  necessary  familiarity  with  disease ;  but,  almost 
from  the  very  beginning,  he  seems  to  have  fully  realized 
that  he  was  destined  to  devote  his  time  and  his  energies  to 
a  very  different  kind  of  professional  work, — ^work  which 
was  urgently  needed,  which  promised  to  be  of  very  great 


CLAUDIUS  GALEN  165 

value  to  medical  science,  and  which  probably  no  other 
physician  then  living  was  competent  to  do  effectively. 
Furthermore,  he  was  himself  profoundly  conscious  that  the 
work  in  question  constituted  the  main  object  of  his  life. 
His  own  words  (see  his  statement  with  reference  to  Archi- 
genes,  on  page  174)  show  this  plainly,  and  the  huge  mass  of 
medical  treatises  which  he  wrote  reveal  in  the  most  un- 
mistakable manner  with  what  untiring  persistency  he  pur- 
sued the  path  which  he  believed  it  was  his  duty  to  follow. 
It  being  assumed,  then,  that  such  were  the  motives  which 
actuated  Galen,  was  it  a  mistake  on  his  part  to  conclude 
that  duty  did  not  require  him  to  remain  in  Rome?  The 
question  is  a  difficult  one  to  answer,  and  I  do  not  feel  called 
upon  to  decide  it.  We  do  not,  however,  brand  a  general 
in  the  army  a  coward  because  he  endeavors  to  protect  him- 
self as  much  as  possible  from  danger  during  a  battle,  that 
he  may  be  able,  to  the  very  end,  to  direct  the  soldiers  under 
his  command.  Similarly,  was  not  Galen  justified  in  avoid- 
ing every  risk  which  was  likely  to  imperil  the  performance 
of  duties  which  were  of  far  greater  value  to  medicine  and 
to  humanity  at  large  than  that  of  acting  as  a  mere  soldier 
in  the  ranks  of  medical  men  ? 

It  seems  a  great  pity  that  one  of  the  most  inspiring  fig- 
ures in  the  history  of  medicine  should  be  represented  to 
posterity  with  such  a  blemish  upon  his  character,  and  I 
have  therefore  ventured  to  suggest  a  possible  defense  of 
Galen's  action. 

Not  very  long  after  he  had  returned  to  Pergamum, 
Galen  was  summoned  by  the  Emperors  Marcus  Aurelius 
and  Lucius  Verus,  who  were  then  with  the  army  at  Aqui- 
leia,  a  few  miles  north  of  the  present  Trieste,  to  join  them 
at  that  city;  and  he  was,  of  course,  obliged  to  obey.  A 
fresh  outbreak  of  the  Plague  had  occurred  and  there  had 
already  been  many  fatal  cases  among  the  troops.  It  was 
therefore  decided  by  the  emperors,  almost  immediately 
after  Galen's  arrival,  to  return  to  Rome  with  a  part  of 
the  army.  A  start  was  accordingly  made,  and  the  company 
had  already  advanced  some  distance  on  their  way,  when 
Lucius   Verus   died.     This  unexpected   event  greatly  in- 


166  GROWTH  OF  MEDICINE 

creased  the  difficulties  of  the  return  journey,  as  it  was 
deemed  necessary  to  carry  the  remains  of  the  deceased 
Emperor  back  to  the  imperial  city.  Thus  Galen  found 
himself  once  more  settled  in  Rome,  this  time  in  the  capacity 
of  private  physician  to  the  Emperor  Marcus  Aurelius  and 
his  sons  Commodus  and  Sextus.  The  position  was  ex- 
tremely well  adapted  to  the  needs  of  Galen,  who,  from  that 
time  forward,  for  a  period  of  several  years,  had  at  his 
disposal  ample  time  for  writing  and  for  conducting  his 
experimental  work  in  anatomy  and  physiology,  a  privilege 
of  which  he  appears  to  have  made  excellent  use.  He  lived 
to  be  seventy  years  of  age,  his  death  occurring  during  the 
latter  part  of  the  reign  of  Severus,  or  at  the  beginning 
of  that  of  Caracalla  (about  201  A.  D.). 

All  Galen's  critics  agree  that  he  possessed  his  full  share 
of  peculiarities, — not  to  call  them  by  the  harsher  name  of 
faults.  He  was  constantly  ready,  for  example,  to  praise 
his  own  doings  and  sayings,  and  he  rarely  lost  an  oppor- 
tunity of  holding  up  the  physicians  of  Rome  to  ridicule  and 
contempt^  He  was  specially  bitter  in  his  criticisms  of 
Methodism  and  its  adherents — ''the  donkeys  of  Thessa- 
lus,"  as  he  called  them.  At  the  same  time,  no  other  physi- 
cian of  ancient  or  modern  times  has  manifested  to  an  equal 
degree  such  extraordinary  industry  as  a  writer  and  original 
investigator  in  a  great  variety  of  departments  of  knowl- 
edge. Although  many  of  his  works  have  been  lost,^  those 
which  have  come  down  to  our  time  are  still  very  numer- 
ous— ' '  a  sufficient  number, ' '  says  Neuburger, ' '  to  constitute 
a  library  by  themselves."  I  give  here  a  few  of  the  titles 
of  these  works,  in  order  that  the  reader  may  get  at  least 
some  idea  of  the  great  variety  of  medical  topics  which 
Galen  has  discussed  in  his  writings.  The  more  complete 
list  furnished  by  Daniel  Le  Clerc  contains  nearly  two 
hundred  titles,  and  yet  even  this  is  believed  to  fall  short 
of  the  actual  number. 

1  The  majority  of  the  writings  of  Galen  are  reported  to  have  been  kept,  for 
safe  preservation,  in  the  Temple  of  Peace,  near  the  Forum ;  and  the  destruc- 
tion of  this  building  by  fire,  during  the  latter  half  of  the  second  century,  en- 
tailed the  loss  of  all  these  valuable  works. 


CLAUDIUS  GALEN  167 

SELECTED  LIST  OF  THE  WOEKS  OF  GALEN  EELATING  TO 
MEDICINE.     (FEOM  LE  CLEEC.) 

Explanation  of  some  of  the  Ancient  Terms  Employed  by 
Hippocrates. 

On  the  Establishment  of  the  Art  of  Medicine. 

Definitions  of  Medical  Terms. 

On  the  Different  Sects  in  Medicine. 

Discourse  against  the  Empirics. 

On  the  Importance,  for  a  Physician,  of  a  Thorough  training  in 
Philosophy. 

The  Physician;  or  Introduction  to  Medicine. 

The  Elements,  as  taught  by  Hippocrates.     (2  books.) 

The  Different  Temperaments.     (3  books.) 

On  the  Nature  of  Man;  Commentaries  on  two  Books  of  Hip- 
pocrates.    (2  books.) 

The  Humors. 

Do  the  Arteries  Normally  contain  Blood  ? 

On  Black  Bile. 

On  the  Bones.     (For  Students  in  anatomy.) 

Dissection  of  the  Vocal  Organs. 

The  Anatomy  of  the  Eyes. 

Dissection  of  the  Veins  and  Arteries. 

Dissection  of  the  Nerves. 

On  the  Utility  of  the  Different  parts  of  the  Body.     (17  books.) 

On  the  Natural  Faculties.     (3  books.) 

The  Sentiments  of  Hippocrates  and  of  Plato.     (9  books.) 

The  Organ  of  Smell. 

The  Movements  of  the  Muscles.     (2  books.) 

The  Physiology  of  Respiration. 

On  Obesity. 

On  the  Maintenance  of  Health.     (6  books.) 

The  Characteristics  of  Different  Foods.     (3  books.) 

Precepts  regarding  the  Diet  best  suited  to  the  Four  Different 
Seasons  and  to  Each  of  the  Twelve  Months  of  the  Year. 

On  the  Manner  of  Living  best  suited  to  those  who  Wish  to  Pre- 
serve their  Health.     (3  books.) 

On  Habit. 

On  the  Differences  between  Diseases. 

On  the  Causes  of  Diseases. 

On  Marasmus  or  Consumption. 

On  the  Different  Kinds  of  Fevers.     (2  books.) 

On  Thirst. 


168  GROWTH  OF  MEDICINE 

On  the  Parts  of  the  Body  Affected.     (6  books.) 
The  Diseases  of  Women. 
The  Different  Kinds  of  Pulse.     (16  books.) 
The  Different  Kinds  of  Urine. 
On  Critical  Days.     (3  books.) 

Commentaries  on  the  Treatises  of  Hippocrates.     (39  books.) 
On  the  Manner  of  Treating  Different  Maladies.     (17  books.) 
On  Venesection.     (3  books.) 
On  the  Use  of  Cups,  Leeches  and  Scarifications. 
On  Purgatives.     (3  books.) 
On  Colic. 
On  Jaundice. 

On  Gout.  / 

On  Stone  in  the  Bladder. 
Etc. 

The  numerous  works  of  Galen,  says  Pagel,  constitute  a 
complete  and  very  satisfactory  encyclopaedia  of  medicine. 
The  most  available  edition  of  his  works  in  Greek  is  that 
of  Karl  Gottlob  Kiihn  of  Leipzig  (1821-1828;  22  Vols,  of 
about  1000  pages  each).  There  is  scarcely  a  department 
which  this  great  physician  has  not  treated  quite  fully. 
But,  unfortunately,  the  translations  into  modern  languages 
are  relatively  few,  and  they  cover  only  small  portions  of 
the  entire  work.  That  of  Daremberg,  entitled  '^Oeuvres 
anatomiques,  physiologiques  et  medicales  de  Galien,  etc.^* 
(Paris,  1854-1857;  2  Vols.),  is  in  every  way  most  satis- 
factory, and  it  is  from  this  source  that  I  have  made  a  few 
extracts — ^just  sufficient  to  give  the  reader  some  idea  of 
Galen 's  style  of  writing  and  of  his  competency  to  deal  with 
such  subjects  as  human  anatomy  and  physiology.  To 
attempt  anything  like  a  complete  exposition  of  his  views 
regarding  pathology,  therapeutics,  hygiene,  etc.,  would 
necessitate  my  devoting  more  space  to  this  part  of  the 
history  of  medicine  than  I  can  afford  to  give.  To  those 
who  desire  to  obtain  more  ample  information  about 
Galen's  views  regarding  pathology  and  therapeutics  I 
would  recommend  a  study  of  Daremberg 's  admirable  work 
and  a  perusal  of  the  careful  analysis  made  by  Neuburger 
of  certain  portions  of  Galen's  text. 

Galen's  Contributions  to  Anatomy  and  Physiology. — ^At 


CLAUDIUS  GALEN  169 

the  period  of  time  about  which  I  am  now  writing,  and  for 
many  centuries  afterward,  there  existed  among  all  classes 
of  the  community  a  very  strong  prejudice  against  dissecting 
human  corpses.  And  even  Galen  himself  appears  to  have 
shared  this  prejudice,  for,  in  spite  of  his  intense  eagerness 
to  gain  a  more  perfect  knowledge  of  human  anatomy,  he 
apparently  did  not  dare  to  undertake  any  such  investiga- 
tion, even  when  a  favorable  opportunity  for  so  doing  pre- 
sented itself,  as  it  did  on  the  occasion  to  which  he  refers 
in  the  following  brief  extract  taken  from  one  of  his 
treatises : — 

A  carelessly  constructed  sepulchre  on  the  banks  of  a  river  had 
been  undermined  during  a  season  of  flood,  and  the  corpse  thus  set 
free  had  floated  down  stream  a  short  distance,  until  it  finally 
lodged  on  the  shore  of  a  small  cove.  Passing  near  by  I  had  the 
opportunity  of  inspecting  this  corpse.  The  fleshy  parts  had  already 
disappeared  to  a  great  extent  through  the  process  of  decomposition, 
but  the  bones  were  still  held  together  by  their  fibrous  connections. 
The  picture  presented  to  the  eye  was  that  of  a  human  skeleton 
specially  prepared  for  the  instruction  of  young  physicians.  On 
another  occasion,  a  few  steps  from  the  main  road,  I  came  across 
the  dead  body  of  a  robber  who  had  been  killed  by  the  traveler 
whose  money  he  had  attempted  to  steal.  The  peasants  of  that 
neighborhood  were  not  willing  to  bury  the  corpse  of  such  a  bad 
man,  and  they  accordingly  allowed  it  to  remain  at  the  spot  where 
it  was  first  discovered.  In  the  course  of  the  following  two  days, 
as  might  be  expected,  the  vultures  removed  every  particle  of  flesh 
from  the  bones,  so  that,  when  I  saw  what  remained  of  the  body, 
the  only  thing  visible  was  a  nicely  cleaned  skeleton. 

(Le  Clerc:  Histoire  de  la  Medecine,  p.  711.) 

Here  were  two  excellent  opportunities  for  gaining  the 
additional  knowledge  of  human  anatomy  which  Galen  so 
much  desired,  but  he  evidently  was  not  at  all  disposed  to 
avail  himself  of  them — doubtless  because  his  mind  was 
deeply  imbued  with  the  feeling  that  any  such  interference 
on  his  part  would  be  a  sacrilegious  act.  Under  the  circum- 
stances, therefore,  there  was  nothing  left  for  him  to  do  but 
to  utilize  animals  for  purposes  of  dissection,  and  more 
particularly  apes,  whose  anatomy  very  closely  resembles 


170  GROWTH  OF  MEDICINE 

that  of  the  human  being.  Several  of  Galen's  books  on 
anatomy  have  come  down  to  our  time,  but  quite  a  number 
of  others  have  been  lost.  From  those  which  we  possess, 
and  especially  from  the  one  entitled  ''Anatomical  Admin- 
istrations," it  is  permissible  to  conclude  that  he  was  a 
most  skilful  dissector  and  an  extremely  close  and  careful 
observer,  and  that  he  was  very  particular  to  set  down 
the  results  of  his  observations  in  admirably  clear  language. 
Indeed,  Le  Clerc  assures  us  that  Vesalius,  the  great  Flemish 
anatomist  of  the  sixteenth  century,  bestowed  high  praise 
upon  Galen's  anatomical  descriptions;  and  that,  too,  not- 
withstanding the  fact  that  the  latter  sometimes  erred  in 
his  statements  regarding  the  similarity  between  certain 
parts  observed  in  dissections  of  an  animal  and  the  corre- 
sponding parts  in  man.  In  one  of  his  treatises-  Galen 
states  distinctly  that  the  arteries  contain  blood.  In  another 
he  gives  a  remarkably  full  and  accurate  description  of  the 
nervous  system,  including  the  brain,  spinal  cord,  and  many 
of  the  nerves. 

He  describes  the  optic  nerve,  the  oculo-motorius  and  trochlearis, 
the  different  ramifications  of  the  trigeminus,  the  acusticus  and 
facialis,  the  vagus  and  glossopharyngeus,  the  nerves  of  the  pharynx 
and  larynx,  the  sympatheticus  (with  the  accompanying  ganglia), 
and  the  radial,  ulnar,  median,  crural  and  ischiatic  nerves.  (Pusch- 
mann. ) 

Although  it  is  true  that  certain  important  anatomical  and 
physiological  facts  are  found  recorded  for  the  first  time 
in  the  works  of  Galen,  this  must  not  be  accepted  as  evidence 
that  Galen  himself  is  the  real  discoverer  of  these  facts. 
The  most  that  can  be  claimed  for  him  is  that  he  is  the  first 
writer  to  bring  the  facts  in  question  to  the  knowledge  of 
us  moderns.  When  the  ancient  books  that  have  been  lost 
are  once  more  brought  to  light,  as  they  very  well  may  be 
at  any  time,  we  shall  be  able,  perhaps,  to  give  credit  where 
credit  is  due.  But  there  is  one  department  in  which  Galen 
did  experimental  work  of  an  entirely  original  character  and 
for  which  he  deserves  unstinted  praise.  I  refer  to  the 
experiments  which  he  made  concerning  the  physiology  of 

2  Book  VI.,  Chapter  XVII.  (page  441  of  Vol.  I.  of  Daremberg's  version). 


CLAUDIUS  GALEN  171 

the  brain  and  spinal  cord.  They  are  related  in  the 
following  extract,  which  has  been  translated  from  the 
account  given  by  Neuburger  {op.  cit.,  Vol.  I.,  p.  380) : — 

The  brain  itself  is  not  sensitive;  it  expands  and  contracts 
synchronously  with  the  respiratory  movements,  the  purpose  of 
which  action  is  to  drive  the  pneuma  from  the  cavities  of  that  organ 
into  the  nerves.  The  function  of  the  meninges  is  to  hold  the  parts 
firmly  together  and  to  unite  the  blood-vessels.  Pressure  upon  the 
brain  causes  stupor.  An  injury  of  the  tissues  surrounding  the 
fourth  ventricle  or  of  those  which  constitute  the  beginning  of  the 
spinal  cord  produces  death.  The  seat  of  the  soul  is  in  the  sub- 
stance of  the  brain,  and  not  in  its  membranes.  The  spinal  cord 
serves  as  a  conductor  of  sensation  and  of  motor  impulses,  and  it 
also  plays  the  part  of  a  brain  for  those  structures  of  the  body 
which  lie  below  the  head.  It  gives  off  nerves  like  streamlets. 
Division  of  the  spinal  cord  longitudinally  in  its  median  axis  does 
not  give  rise  to  paralysis.  Transverse  division,  on  the  other  hand, 
causes  symmetrical  paralyses.  If  the  cord  is  divided  between  the 
third  and  fourth  cervical  vertebrae,  respiration  is  arrested,  and 
if  the  division  is  made  between  the  cervical  and  the  thoracic  por- 
tions of  the  spinal  column,  the  animal  breathes  with  the  aid  only 
of  its  diaphragm  and  of  the  upper  muscles  of  the  trunk  of  the 
body.  Division  of  the  recurrent  nerves  produces  aphonia;  if  the 
fifth  cervical  nerve  is  divided,  the  scapular  muscles  on  the  corre- 
sponding side  will  be  paralyzed.  Galen  considers  the  ganglia  to 
be  organs  for  reinforcing  the  energy  of  the  nerves.  The  fact  that 
both  cerebral  and  spinal-cord  nerve-filaments  enter  into  the  com- 
position of  the  sympathetic  nerve  explains  the  extraordinary 
sensitiveness  of  the  abdominal  organs. 

When  we  consider  that  these  experiments  are  the  first 
of  their  kind  of  which  history  makes  mention,  that  they 
were  carried  out  nearly  seventeen  hundred  years  ago,  and 
that — so  far  as  we  know — they  sprang  entirely  from  the 
brain  of  the  experimenter,  we  may  well  express  unlimited 
admiration  for  Claudius  Galen. 

Daniel  Le  Clerc  says  that  Galen's  principal  treatise  on 
human  physiology,  entitled  ''Utility  of  the  Different  Parts 
of  the  Human  Body,"  constitutes  a  chef-d'oeuvre  which 
has  challenged  the  admiration  of  physicians  and  phi- 
losophers in  all  ages.     Christians,  however,  he  adds,  are 


/V 


172  GROWTH  OF  MEDICINE 

particularly  gratified  to  learn  from  this  work  that  ' '  Galen, 
although  classed  as  a  Pagan,  unhesitatingly  recognizes  that 
it  was  an  all-wise,  an  all-powerful,  an  all-good  God  who 
created  man  and  all  the  other  animals."  Further  on, 
Le  Clerc  refers  to  another  statement  which  was  made  by 
Galen  and  which  will  be  found  on  page  261  of  Daremberg's 
version.    It  reads  as  follows: — 

If  I  were  to  spend  any  more  time  in  talking  about  such  brutes — 
by  which  term  he  designates  men  who  cannot  appreciate  the  wisdom 
of  God  in  distributing  the  different  parts  of  the  body  in  the  manner 
in  which  He  has  done  this — I  should  justly  incur  the  blame  of 
sensible  persons.  They  would  accuse  me  of  desecratiag  the  account 
which  I  am  writing,  an  account  which  is  intended  as  a  hymn  of 
sincere  praise  of  the  Creator  of  man.  I  believe  that  true  piety 
consists,  not  in  sacrificing  numberless  hecatombs  nor  in  burning 
unlimited  quantities  of  incense  and  a  thousand  perfumes,  but  in 
first  searching  out  and  then  making  known  to  my  fellow  men  how 
great  are  the  wisdom,  the  power,  and  the  goodness  of  the  Creator. 

Galen's  work  on  ''The  Utility  of  the  Different  Parts  of 
the  Human  Body"  is  composed  of  seventeen  books,  all  of 
which  exist  to-day  in  a  complete  state.  Taken  together 
they  form,  as  may  be  seen  by  the  following  list  of  contents, 
a  remarkably  complete  treatise  on  physiology.  Books  I. 
and  II.  are  devoted  to  the  hand,  forearm  and  arm  (105 
pages) ;  Book  III.  to  the  thigh,  leg  and  foot  (62  pages) ; 
Books  IV.  and  V.  to  the  alimentary  organs  and  their 
accessories  (101  pages) ;  Book  VI.  to  the  respiratory  organs 
(78  pages) ;  Book  VII.  to  the  organs  of  the  voice  (67  pages) ; 
Book  VIII.  to  the  head,  the  encephalon  and  the  organs  of 
special  sense  (45  pages) ;  Book  IX.  to  the  cranium,  the 
encephalon  and  the  cranial  nerves  (38  pages) ;  Book  X.  to 
the  eyes  and  their  accessories  (45  pages) ;  Book  XL  to  the 
face  and  more  particularly  the  jaws  (55  pages) ;  Book 
XII.  to  the  neck  and  the  rest  of  the  spinal  column  (46 
pages) ;  Book  XIII.  to  the  shoulder  and  the  structure  of 
the  spinal  column  in  detail  (40  pages) ;  Books  XIV.  and  XV. 
to  the  genital  organs  and  the  parts  in  which  the  foetus 
develops  (70  pages) ;  Book  XVI.  to  the  nerves,  arteries 
and  veins  (43  pages) ;  and  Book  XVII.  Epilogue  (11  pages). 


CLAUDIUS  GALEN  173 

There  are  very  few  modern  text  books  in  which  the 
author  treats  the  subject  in  as  exhaustive  a  manner  as 
Galen  has  done  in  these  seventeen  books.  As  may  readily 
be  imagined  from  the  great  number  and  length  of  his 
writings,  he  often  wanders  off  into  side  issues  and  thus 
lays  himself  open  to  the  charge  of  being  a  diffuse  writer. 
At  the  same  time  he  cannot  be  accused  of  dullness,  for  in 
reading  Daremberg's  version  one  is  seldom  tempted  to 
omit  any  of  the  text,  and  his  style  is  interesting.  The 
following  brief  extracts,  to  which  should  be  added  that 
given  on  a  previous  page,  may  be  taken  as  fair  samples  of 
his  manner  of  treating  questions  in  the  department  of 
physiology : — 

Reasons  why  the  Alae  Nasi  are  Cartilaginous  and  why  they  may 
he  Moved  by  Voluntary  Muscular  Action. — ^We  have  already 
explained  in  some  measure  the  reasons  why  the  alae  nasi  should 
be  composed  of  cartilage  and  why  it  should  be  possible  for  the 
animal  to  move  them  at  will.^  It  is  an  established  fact  that  the 
movements  of  these  parts  are  competent  to  aid  in  no  small  degree 
the  somewhat  forcible  inspirations  and  expirations.  This  is  the 
reason  why  the  alae  are  constructed  in  such  a  manner  as  to  be 
easily  movable.  They  are  made  of  cartilage  because  this  substance 
is  hard  to  fracture  or  to  tear  apart.  The  placing  of  these  alar 
movements  under  the  control  of  the  will,  and  not  under  that  of 
some  other  bodily  force  (like  the  arterial  impulse,  for  example), 
is  certainly  an  excellent  arrangement;  and,  if  one  does  not  appre- 
ciate this  without  any  further  explanation,  it  must  be  because  my 
previous  reasonings  about  such  matters  have  fallen  upon  inatten- 
tive ears. 

(Translated  from  Book  XI.,  Chapter  XVII.,  of  Daremberg's 
French  version  of  Galen's  works.) 

Another  brief  extract  may  be  given  here.  It  forms  a 
part  of  the  chapter  relating  to  the  action  of  the  sigmoid 
valves  of  the  pulmonary  artery,  etc.,  and  merits  special 
attention  because  it  furnishes  additional  evidence  of  the 

8  In  his  Commentaries  on  the  works  of  Hippocrates  (Epidemic  Diseases, 
III.,  t.  XVII.  B.  $  4)  Galen  states  that  he  has  often  observed  this  to-and- 
fro  movement  of  the  alae  nasi  in  certain  cases  of  illness  and  that  he  has 
interpreted  it  as  indicating  the  existence  of  some  serious  disorder  of  the 
respiratory  tract.     (Daremberg.) 


/J 


174  GROWTH  OF  MEDICINE 

correctness  of  Daremberg's  statement  that  Galen  was  the 
leader  of  the  most  advanced  school  of  experimentation: — 

The  more  strongly  the  thorax,  in  its  exertion  of  a  compressing 
force,  tends  to  drive  the  blood  (out  of  the  heart),  the  more  tightly 
do  these  membranes  (the  sigmoid  valves)  close  the  opening. 
Invested  in  a  circular  manner  from  within  outward,  extending 
throughout  the  entire  circumference  of  the  interior  of  the  vessel, 
these  membranous  valves  are,  each  one  of  them,  so  accurately 
patterned  and  so  perfectly  fitted  that  when  they  are  put  upon  the 
stretch  by  the  column  of  blood,  they  constitute  a  single  large 
membrane  which  closes  (watertight)  the  orifice.  Pushed  back  by 
the  return  flow  of  the  blood,  they  fall  back  against  the  inner  sur- 
face of  the  vein,  and  permit  an  easy  passage  of  the  blood  through 
the  amply  dilated  orifice  (which  they,  an  instant  before,  closed  so 
perfectly). 

(Translated  from  Book  VI.,  Chapter  XI.,  of  Daremberg's  French 
version  of  the  works  of  Galen.) 

In  his  comments  upon  the  account  of  the  sigmoid  valves 
which  I  have  just  quoted,  Daremberg  says  that  the  descrip- 
tion of  these  structures  given  by  Erasistratus  at  least  four 
hundred  years  earlier  is  admitted  by  Galen  to  be  so  correct 
that  it  would  scarcely  be  possible  to  furnish  a  better  one. 

Galen's  Remarks  upon, the  Subject  of  Diagnosis. — In  the 
treatise  entitled  ''On  the  parts  of  the  Body  Affected" 
(Book  IL,  Chapter  X.)  Galen  gives  the  following  advice 
with  regard  to  the  method  which  it  is  desirable  to  adopt 
when  one  wishes  to  ascertain  which  part  or  organ  is 
affected,  what  is  the  nature  of  the  disease  there  located, 
and  whether  it  is  primary  in  its  nature  or  secondary  to 
some  affection  of  earlier  development: — 

It  should  have  been  the  special  duty  of  Archigenes,  who  appeared 
on  the  scene  next  in  order  after  a  series  of  the  most  illustrious 
physicians,*  to  infuse  more  light  into  medical  teaching.    Unfortu- 

4  Hippocrates,  Herophilus,  Erasistratus,  Asclepiades,  Themison,  Celsus,  Sora- 
nus  and  Athenaeus.  Daremberg  calls  attention  to  the  fact  that,  although  we 
possess  to-day  only  a  few  fragments  of  the  writings  of  Archigenes,  those  few 
are  of  such  a  degree  of  excellence  that  we  may  well  ask  ourselves  whether 
Galen  was  not  perfectly  justified  in  placing  such  a  high  estimate  as  he  ap- 
pears to  have  done  upon  the  merits  of  this  writer, — and  that,  too,  notwith- 


CLAUDIUS  GALEN  175 

nately,  he  did  the  very  opposite ;  for  we  who  have  grown  old  in  the 
exercise  of  the  art  (and  should  therefore  find  it  easy  to  comprehend 
what  is  written  about  medicine),  are  at  times  unable  to  understand 
what  he  says.  Such  being  the  true  state  of  affairs,  I  now  propose 
to  undertake  what  Archigenes  failed  to  accomplish.  I  shall  com- 
mence by  indicating  in  a  general  way  what  is  the  proper  method 
to  adopt  when  one  wishes  to  ascertain  in  what  part  or  organ  the 
disease  is  located  and  how  one  should  proceed  when  it  is  proposed 
to  teach  the  method  to  others.  This  method  may  be  stated  in  the 
following  terms : — 

In  the  first  place,  the  part  should  be  carefully  examined  in  order 
that  we  may  ascertain  whether  it  presents  any  signs  of  special 
value  as  indicating  the  nature  of  the  disease.  In  the  next  place, 
it  is  important  in  such  an  examination  to  know  beforehand  what 
are  the  particular  signs  which  belong  to  each  of  the  diseases  that 
may  affect  the  part  or  organ  in  question,  and  also  whether  these 
signs  vary  according  to  the  particular  section  of  the  organ  involved. 
In  inflammation  of  the  lung,  for  example,  there  are:  difficulty  in 
breathing  (dyspnoea)  and  great  general  distress  (malaise),  the 
patient  being  obliged  to  remain  in  a  sitting  posture  (orthopnoea) — 
all  of  which  are  signs  indicating  the  possibility  of  suffocation. 
Furthermore,  the  air  expired  from  the  infected  lung  is  sensibly 
hot,  especially  if  the  inflammation  is  of  the  erysipelatous  variety, 
and,  as  a  consequence,  the  patient  shows  a  disposition  to  draw  long 
breaths,  knowing  that  the  cold  air  which  he  thus  draws  into  his 
lungs  will  afford  him  some  measure  of  relief.  The  sputa  expecto- 
rated when  he  coughs  are  differently  colored;  some  being  red, 
yellowish,  or  of  a  rusty  appearance,  while  others  are  almost  black, 
livid,  or  frothy.  The  patient  also  often  experiences  the  sensation 
of  a  heavy  weight  in  his  chest,  together  with  more  or  less  pain, 
which  seems  to  be  located  deep  down  in  that  region  and  which 
shoots  backward  into  his  spinal  column  or  forward  toward  the 
sternum.  Add  to  these  manifestations  a  high  fever  and  a  pulse 
such  as  we  have  already  described  on  another  page,  and  you  will 
have 

(Translated  from  Daremberg's  French  version  of  Galen's  works.) 

It  has  been  said  that  Galen  possessed  more  than  the 
ordinary  share  of  vanity  with  regard  to  his  cleverness  as 

standing  the  unfavorable  criticism  which  he  makes  in  the  present  paragraph 
about  the  author's  failure  at  times  to  write  with  sufficient  clearness  on  med- 
ical subjects. 


176  GROWTH  OF  MEDICINE 

a  diagnostician;  and  certainly  some  of  the  accounts  which 
he  gives,  in  his  clinical  and  scientific  treatises,  of  his  own 
experiences,  seem  to  bear  out  this  accusation.  One  hesi- 
tates to  expose  the  weak  spots  in  the  character  of  one  of 
the  really  great  men  of  antiquity  lest  such  exposure  may 
convey  a  wrong  impression;  at  the  same  time  it  would  be 
an  error  to  represent  him  as  a  man  entirely  free  from  the 
foibles  common  to  humanity, — even  to  the  best  and  wisest 
of  men.  I  therefore  repeat  here  Galen's  own  account  of 
a  professional  visit  which  he  made  to  a  brother  physician 
whose  malady  presented  to  himself  and  to  his  friends  many 
obscure  features. 

Upon  the  occasion  of  my  first  visit  to  Rome  I  completely  won  the 
admiration  of  the  philosopher  Glaucon  by  the  diagnosis  which  I 
made  in  the  case  of  one  of  his  friends.  Meeting  me  one  day  in  the 
street  he  shook  hands  with  me  and  said :  "I  have  just  come  from 
the  house  of  a  sick  man,  and  I  wish  that  you  would  visit  him  with 
me.  He  is  a  Sicilian  physician,  the  same  person  with  whom  I  was 
walking  when  you  met  me  the  other  day."  "What  is  the  matter 
with  him?"  I  asked.  Then  coming  nearer  to  me  he  said,  in  the 
frankest  manner  possible :  ' '  Gorgias  and  Apelas  told  me  yesterday 
that  you  had  made  some  diagnoses  and  prognoses  which  looked  to 
them  more  like  acts  of  divination  than  products  of  the  medical  art 
pure  and  simple.  I  would  therefore  like  very  much  to  see  some 
proof,  not  of  your  knowledge  but  of  this  extraordinary  art  which 
you  are  said  to  possess."  At  this  very  moment  we  reached  the 
entrance  of  the  patient's  house,  and  so,  to  my  regret,  I  was  pre- 
vented from  having  any  further  conversation  with  him  on  the 
subject  and  from  explaining  to  him  how  the  element  of  good  luck 
often  renders  it  possible  for  a  physician  to  give,  as  it  were  off- 
hand, diagnoses  and  prognoses  of  this  exceptional  character.  Just 
as  we  were  approaching  the  first  door,  after  entering  the  house, 
we  met  a  servant  who  had  in  his  hand  a  basin  which  he  had 
brought  from  the  sick  room  and  which  he  was  on  his  way  to  empty 
upon  the  dung  heap.  As  we  passed  him  I  appeared  not  to  pay 
any  attention  to  the  contents  of  the  basin,  but  at  a  mere  glance  I 
perceived  that  they  consisted  of  a  thin  sanio-sanguinolent  fluid, 
in  which  floated  excrementitious  masses  that  resembled  shreds  of 
flesh — an  unmistakable  evidence  of  disease  of  the  liver.  Glaucon 
and  I,  not  a  word  having  been  spoken  by  either  of  us,  passed  on 
into  the  patient's  room.    When  I  put  out  my  hand  to  feel  of  the 


CLAUDIUS  GALEN  177 

latter 's  pulse,  he  called  my  attention  to  the  fact  that  he  had  just 
had  a  stool,  and  that,  owing  to  the  circumstance  of  his  having 
gotten  out  of  bed,  his  pulse  might  be  accelerated.  It  was  in  fact 
somewhat  more  rapid  than  it  should  be,  but  I  attributed  this  to 
the  existence  of  an  inflammation.  Then,  observing  upon  the  window 
sill  a  vessel  containing  a  mixture  of  hyssop  and  honey  and  water, 
I  made  up  my  mind  that  the  patient,  who  was  himself  a  physician, 
believed  that  the  malady  from  which  he  was  suffering  was  a 
pleurisy;  the  pain  which  he  experienced  on  the  right  side  in  the 
region  of  the  false  ribs  (and  which  is  also  associated  with  inflam- 
mation of  the  liver)  confirming  him  in  this  belief,  and  thus  induc- 
ing him  to  order  for  the  relief  of  the  slight  accompanying  cough 
the  mixture  to  which  I  have  just  called  attention.  It  was  then 
that  the  idea  came  into  my  mind  that,  as  fortune  had  thrown  the 
opportunity  in  my  way,  I  would  avail  myself  of  it  to  enhance  my 
reputation  in  Glaucon  's  estimation.  Accordingly,  placing  my  hand 
on  the  patient 's  right  side  over  the  false  rib,  I  remarked :  '  *  This 
is  the  spot  where  the  disease  is  located."  He,  supposing  that  I 
must  have  gained  this  knowledge  by  simply  feeling  his  pulse, 
replied  with  a  look  which  plainly  expressed  admiration  mingled 
with  astonishment,  that  I  was  entirely  right.  "And" — I  added 
simply  to  increase  his  astonishment — "you  will  doubtless  admit 
that  at  long  intervals  you  feel  impelled  to  indulge  in  a  shallow, 
dry  cough,  unaccompanied  by  any  expectoration. ' '  As  luck  would 
have  it,  he  coughed  in  just  this  manner  almost  before  I  had  got 
the  words  out  of  my  mouth.  At  this  Glaucon,  who  had  hitherto 
not  spoken  a  word,  broke  out  into  a  volley  of  praises.  "Do  not 
imagine,"  I  replied,  "that  what  you  have  observed  represents 
the  utmost  of  which  medical  art  is  capable  in  the  matter  of  fathom- 
ing the  mysteries  of  disease  in  a  living  person.  There  still  remain 
one  or  two  other  symptoms  to  which  I  will  direct  your  attention. ' ' 
Turning  then  to  the  patient  I  remarked:  "When  you  draw  a 
longer  breath  you  feel  a  more  marked  pain,  do  you  not,  in  the 
region  which  I  indicated;  and  with  this  pain  there  is  associated 
a  sense  of  weight  in  the  hypochondrium  ? "  At  these  words  the 
patient  expressed  his  astonishment  and  admiration  in  the  strongest 
possible  terms.  I  wanted  to  go  a  step  farther  and  announce  to 
my  audience  still  another  symptom  which  is  sometimes  observed 
in  the  more  serious  maladies  of  the  liver  (scirrhus,  for  example), 
but  I  was  afraid  that  I  might  compromise  the  laudation  which 
had  been  bestowed  upon  me.  It  then  occurred  to  me  that  I  might 
safely  make  the  announcement  if  I  put  it  somewhat  in  the  form 


178  '■      GROWTH  OF  MEDICINE 

of  a  prognosis.  So  I  remarked  to  the  patient:  "You  will  prob- 
ably soon  experience,  if  you  have  not  already  done  so,  a  sensation 
of  something  pulling  upon  the  right  clavicle."  He  admitted  that 
he  had  already  noticed  this  symptom.  "Then  I  will  give  just 
one  more  evidence  of  this  power  of  divination  which  you  believe 
that  I  possess.  You,  yourself,  before  I  arrived  on  the  scene,  had 
made  up  your  mind  that  your  ailment  was  an  attack  of  pleurisy, 
etc." 

Glaucon's  confidence  in  me  and  in  the  medical  art,  after  this 
episode,  was  unbounded. 

Thirty  or  forty  years  elapsed  after  Galen's  death  before 
the  Profession  began  to  realize  how  great  an  authority  he 
had  become  in  all  matters  relating  to  medicine ;  not  perhaps 
among  the  majority  of  physicians,  but  among  the  better 
educated  and  those  more  given  to  reasoning  about  the 
various  problems  in  physiology  and  pathology.  Then  came 
the  invasion  of  Eome  by  the  Barbarians,  and  with  it  the 
scattering  of  nearly  all  those  who  were  at  the  time  prac- 
ticing medicine  in  that  great  city.  This  was  the  beginning 
of  the  long  period  known  as  the  Middle  Ages,  a  period 
during  which,  so  far  as  Italy  and  Gaul  were  concerned,  the 
science  of  medicine  made  no  advance  whatever.  The 
physicians  living  in  a  precarious  manner  in  the  to^vns,  and 
the  monks  who  practiced  medicine  in  the  country  districts, 
took  very  little  interest,  as  may  readily  be  imagined,  in  the 
achievements  of  Galen.  Through  all  those  years  they 
clung  to  the  doctrines  of  the  Methodists,  as  revealed  to 
them  in  the  work  of  Caelius  Aurelianus,  the  favorite 
medical  treatise  of  that  period.  It  was  only  during  the 
latter  part  of  the  Middle  Ages  that  Galen's  teachings 
began  once  more  to  be  appreciated  at  their  true  value; 
and,  as  time  went  on,  they  gained  a  stronger  and  stronger 
hold  on  the  minds  of  medical  men,  until  finally  they  held 
undisputed  sway.  Friedlaender,  speaking  of  medicine  in 
those  dark  times,  uses  these  words:  *' Galen's  colossal 
personality  loomed  up  throughout  that  long  night  as  a 
brilliant  guiding  star  to  light  the  intricate  pathways  of 
medicine. ' ' 


CHAPTER  XVI 

THE  INFLUENCE  OF  CHRISTIANITY  UPON  THE 
EVOLUTION  OF  MEDICINE 

The  religion  established  by  Jesus  Christ  in  Judea  during 
the  early  part  of  the  first  century  remained  confined  within 
the  limits  of  that  region  for  a  number  of  years,  but  already 
during  the  latter  half  of  that  period  groups  of  Christians 
were  to  be  found  in  every  part  of  the  Roman  Empire,  and 
in  certain  localities  the  membership  of  the  new  church  had 
increased  so  greatly  in  numbers  as  to  excite  the  alarm  and 
hostility  of  the  temple  priests  and  of  the  governing  officials. 
Persecutions,  especially  in  the  city  of  Rome  and  at  the 
instigation  of  Nero,  became  more  and  more  frequent  and 
more  and  more  pitiless,  but  they  failed  utterly  to  destroy 
the  new  religion,  so  firmly  was  it  rooted  in  the  followers 
of  Jesus  Christ.  As  a  matter  of  fact  its  spread  was 
checked  for  only  a  few  years,  and  then  its  adherents 
increased  in  numbers  more  rapidly  than  ever.  Neuburger, 
in  his  '* History  of  Medicine,"  makes  the  following  quota- 
tion from  the  account  which  Dionysius  of  Alexandria  gives 
of  the  great  plague  that  occurred  during  the  third  century 
A.  D.: 

The  majority  of  our  brethren  in  their  love  for  their  neighbors 
did  not  spare  themselves,  but  acted  as  a  unit  in  their  efforts  to 
assist.     They  visited  the  sick  without  the  slightest  fear  and  gave 

them  the  very  best  of  care,  for  the  sake  of  Christ Among 

the  non- Christians,  however,  the  very  opposite  was  true.  As  soon 
as  any  of  their  number  fell  ill  they  pushed  them  to  one  side,  even 
those  who  were  dearest  to  them,  and,  before  they  were  more  than 
half-dead,  they  threw  them  out  into  the  street  and  took  no  care  to 
bury  the  dead  bodies. 


180  GROWTH  OF  MEDICINE 

Such  an  example  of  self-sacrifice  and  humanity — and 
there  must  have  been  very  many  similar  examples — could 
not  possibly  have  failed  to  make  a  profound  impression 
upon  the  community  at  large.  Daniel  Le  Clerc  says  that 
three  physicians  suffered  martyrdom  for  their  Christian 
faith  during  the  reigns  of  the  Emperors  Marcus  Aurelius, 
Lucius  Verus  and  Commodus.  They  were  Papila  (of 
Pergamum),  Alexander  (of  Lyons)  and  Sanctus  (a  con- 
temporary of  Galen),  whose  death  was  of  a  particularly 
cruel  character.  Credit  should  also  be  given  to  Chris- 
tianity, says  the  same  writer,  for  having  established  the 
rule  that  every  community  should  assume  the  expense  and 
responsibility  of  caring  for  its  own  poor  and  sick.  This 
was  a  step  of  the  greatest  importance ;  and,  at  a  still  later 
period,  when  Christianity  became  largely  an  affair  of  the 
state,  a  complete  hospital  organization  was  effected,  with 
the  bishop  as  the  chief  officer  and,  under  him,  deacons  and 
deaconesses.  Such  well-organized  institutions  proved  to 
be  of  the  greatest  possible  benefit  to  the  advance  of  medical 
science.  They  were  the  worthy  successors  of  those  more 
ancient  hospitals,  the  Aesculapian  temples,  which  were  first 
established  by  the  Greeks  in  the  pre-Hippocratic  age,  and 
they  have  continued  in  an  unbroken  chain  from  the  institu- 
tions of  those  primitive  times  to  the  thoroughly  well- 
equipped  hospitals  of  the  present  day. 

In  330  A.  D.  the  new  capital  of  the  Eoman  Empire  was 
established  in  Byzantium,  afterward  called  Constanti- 
nople, and  Eome,  which  for  hundreds  of  years  had  been 
the  metropolis  of  the  world  and  the  source  from  which  a 
large  part  of  Roman  history  had  emanated,  was  given  a 
subordinate  position.  Then  followed,  in  410  A.  D.,  the 
conquest  of  the  latter  city  by  the  Visigoths,  a  horde  of 
uneducated  Barbarians  who  had  felt  the  might  of  Rome 
in  previous  years,  and  who  now  doubtless  took  immense 
satisfaction  in  humiliating  her  and  in  destroying  her 
valuable  possessions.  There  are  good  reasons  for  believing 
that,  when  the  Emperor  Constantine  established  his  resi- 
dence in  Byzantium,  the  leading  physicians  of  Rome 
followed  him ;  and  it  is  not  likely  that  many  of  those  who, 


TEE  INFLUENCE  OF  CHRISTIANITY        181 

for  one  reason  or  another,  preferred  to  remain  in  the  old 
capital,  continued  to  do  so  after  it  became  known  that  the 
Barbarians  were  approaching  the  city.  But  the  migration 
of  these  physicians  to  the  new  capital  did  not  mean  a 
renewal  there  of  the  scientific  activity  which  had  charac- 
terized the  growth  of  Greek  medicine  in  Rome  during  the 
first  two  centuries  of  the  Christian  Era.  It  is  probable  that 
the  fugitives,  being  obliged  to  travel  with  the  smallest 
amount  of  baggage  possible,  left  the  major  part  of  their 
books  and  papyrus  rolls  behind,  hoping,  no  doubt,  that  they 
might  be  able  at  some  later  date  to  recover  them.  But  the 
favorable  occasion  never  arrived,  and  thus  a  great  deal 
of  valuable  medical  literature  entirely  disappeared.  The 
loss,  however,  might  have  been  even  more  serious  than  it 
was  if  the  Christian  church  had  not  already  (during  the 
third  century)  begun  to  establish  monasteries  in  secluded 
and  inaccessible  spots.  It  was  to  these  institutions  that 
not  only  books  of  a  religious  character,  but  also  those 
relating  to  the  science  of  medicine,  were  transported  for 
safe  keeping  during  the  early  Middle  Ages.  Farther  on, 
I  shall  have  occasion  to  refer  to  this  subject  again  and  to 
discuss  more  fully  certain  other  benefits  which  accrued 
to  medical  science  from  these  monastic  institutions. 

But  while,  on  the  one  hand,  the  Christian  church  through 
the  instrumentality  of  the  monasteries  was  lending  its  aid 
to  the  preservation  of  the  sources  of  medical  knowledge, 
it  was,  on  the  other,  doing  its  best  to  arrest  all  further 
evolution  of  that  branch  of  science;  not  consciously,  it 
must  be  admitted,  but  through  a  mistaken  sense  of  its  duty 
to  God.  Thus  it  came  about  that  the  Emperor  Justinian  I. 
(527-567  A.  D.),  acting  under  the  narrow-minded  advice  of 
his  ecclesiastical  counsellors,  closed  the  medical  schools  at 
Athens  and  Alexandria  and  at  the  same  time  withdrew  the 
regular  allowance  of  money  which  up  to  that  time  had  been 
paid  to  the  state  physicians  and  to  special  scholars.  A 
few  years  later,  however  {i.e.,  in  the  early  part  of  the 
seventh  century  A.  D.),  some  of  the  more  highly  educated 
physicians  of  Alexandria  got  together  and  made  the 
attempt  to  organize  a  school  of  medicine  in  that  city.    A 


182  GROWTH  OF  MEDICINE 

course  of  lectures  was  planned  and  sixteen  of  Galen's 
works,  carefully  chosen  for  the  purpose,  were  made  the 
basis  of  the  new  course  of  instruction.  The  books  selected 
were  first  carefully  edited  and  simplified,  and  then  commen- 
taries were  added  in  order  that  in  their  final  >shape  these 
treatises  might  be  better  suited  to  the  uses  of  students. 
The  invasion  of  Alexandria  by  the  Arabs,  however,  soon 
put  an  effectual  stop  to  this  promising  attempt  to  revive 
Greek  medicine. 

In  this  brief  sketch  I  have  thus  far  mentioned  only  the 
more  direct  effects  produced  by  the  new  religion  upon  the 
evolution  of  medicine.  The  indirect  effects,  however,  were 
also  in  some  cases  of  very  great  importance.  At  the 
beginning  of  her  history  there  developed  in  the  Christian 
church,  among  her  chief  men,  a  strong  disposition  to 
quarrel  over  dogmas.  To  apply  the  term  quarrelsomeness 
to  this  tendency  may  easily  convey  a  wrong  impression. 
It  was,  more  strictly  speaking,  a  highly  developed  con- 
scientiousness on  the  part  of  men  whose  minds  were  deeply 
imbued  with  the  idea  that  they  were  rendering  God  a  service 
by  keeping  what  they  believed  to  be  the  true  and  only 
religion  free  from  errors  of  all  kinds.  It  took  many 
centuries  to  impress  the  leaders  of  the  church  with  the 
fact  that  the  religion  of  Jesus  Christ,  like  the  science  of 
medicine  or  the  natural  sciences,  was  capable  of  develop- 
ment to  an  almost  indefinite  extent ;  and  it  is  owing  to  our 
appreciation  of  this  important  fact  that  we  moderns  look 
with  so  much  more  lenient  eyes  upon  the  distressing,  not 
to  say  cruel,  events  of  mediaeval  ecclesiastical  history. 
At  the  time  of  which  I  am  now  writing,  however,  it  was 
considered  highly  unchristian — especially  for  one  holding 
authority  in  the  church — to  believe  otherwise  than  as  her 
doctrines  taught;  and  accordingly,  in  the  early  part  of  the 
fifth  century  A.  D.,  Nestorius,  the  Patriarch  of  Constanti- 
nople, was  deposed  from  his  high  office  by  a  Council  of  the 
church  and  imprisoned  because  he  was  unwilling  to  teach 
the  doctrine  of  the  miraculous  birth  of  Jesus  Christ. 
Those  who  accepted  the  view  held  by  Nestorius — and  they 
eventually  became  a  very  numerous  and  a  very  influential 


THE  INFLUENCE  OF  CHRISTIANITY       183 

body  of  Christians — ^were  driven  out  of  Constantinople  and 
compelled  to  seek  homes  in  distant  places.  This  affords, 
perhaps,  an  explanation  of  the  fact  that,  during  the  eighth 
century  A.  D.,  many  Nestorian  Christians  were  found  living 
in  the  eastern  part  of  Syria  and  in  Persia;  and  it  seems 
fair  to  assume  that  these  Christian  communities  repre- 
sented to  some  extent  the  direct  successors  of  those  Nesto- 
rians  who  had  taken  refuge  in  this  remote  corner  of  Asia 
Minor  three  hundred  years  earlier.  Furthermore,  it  is 
highly  probable  that  there  were  Christian  communities  in 
this  region  several  centuries  before  the  Nestorians  arrived, 
for  it  is  believed  that  the  Apostles  James  and  Thomas 
visited  Persia  and  the  northeastern  part  of  Syria  in  the 
course  of  their  work  as  evangelists.  It  is  not  known, 
though,  how  many  of  the  descendants  of  these  earlier 
Christians  adopted  the  peculiar  beliefs  of  the  Nestorian 
refugees. 

And  here  it  should  be  stated  that  the  facts  which  have 
thus  far  been  mentioned  are  not  the  only  ones  that  throw 
some  light  upon  the  relationship  subsisting  between  Chris- 
tianity and  the  spread  of  medical  knowledge  to  Western 
Europe.  Those  which  remain  to  be  considered  are  of  two 
kinds,  viz.,  facts  relating  to  the  origin  of  the  Arabic 
Renaissance,  and  facts  which  show  that  the  Christian 
church,  from  the  fourth  century  onward,  was  contributing 
not  a  little,  through  the  establishment  of  the  great  monastic 
orders,  such  as  the  Benedictines,  the  Dominicans,  and  the 
Franciscans,  to  the  preservation  if  not  to  the  further 
evolution  of  Graeco-Roman  medical  knowledge.  I  shall 
reserve  for  consideration  in  a  later  chapter  this  particular 
part  of  the  history  of  medicine;  and  in  the  meantime  I 
shall  endeavor  to  describe  the  events  which  preceded  and 
rendered  possible  the  active  study  of  Greek  medicine  on 
the  part  of  the  followers  of  Mohammed. 

So  far  as  history  furnishes  us  with  any  information  on 
the  subject,  the  Nestorians  who  lived  in  Persia,  Syria  and 
Mesopotamia  were  Christians  of  a  remarkably  liberal  type. 
They  appear  to  have  been  an  unusually  peaceable  people, 
for  not  only  were  they  kindly  disposed  toward  one  another, 


184  GROWTH  OF  MEDICINE 

but  they  seem  to  have  been  on  the  best  of  terms  with  their 
Jewish  neighbors,  who,  like  themselves,  were  eager  after 
knowledge.  Already  at  a  very  early  period  there  existed 
at  Djondisabour — a  town  which  had  been  founded  in  the 
Province  of  Khorassan,  in  the  northeastern  part  of  Persia, 
about  the  year  260  A.  D.,  by  Sapor  II.,  King  of  that 
country — a  school  in  which  the  medicine  of  Hippocrates 
was  taught.  Freind,  in  his  ''History  of  Physick"  (London, 
1727),  says  that  about  the  year  272  A.  D.  the  Emperor 
Aurelian  (Lucius  Domitius  Aurelianus),  as  a  compliment 
to  his  daughter,  who  was  the  wife  of  the  King  of  Persia, 
sent  to  Djondisabour,  the  city  in  which  she  resided,  several 
Greek  physicians;  and  Abulpharagius,  the  Arab  historian 
(thirteenth  century),  intimates  that  these  were  the  men  who 
conducted  the  teaching  in  the  newly  established  medical 
school.  Another  possibility  suggests  itself.  After  the 
death  of  Alexander  the  Great  in  Babylon  (323  B.  C),  from 
malarial  fever,  it  is  not  unlikely  that  some  of  the  numerous 
Greek  physicians  who  accompanied  the  army  in  an  official 
character,  and  who,  we  are  warranted  in  believing,  were 
exceptionally  well  educated,  decided  not  to  remain  in  that 
unhealthy  district,  but  to  settle  in  some  of  the  neighboring 
towns  {e.g.,  Nisibis  in  the  hill  country  to  the  north  of 
Babylon,  or  Sura  to  the  east  of  the  river  Tigris) ;  and  that 
these  men  also  contributed  their  share  toward  the  planting 
and  perpetuation  of  Greek  medicine  in  this  district  of  the 
Orient.  However,  the  salient  fact  in  this  period  of  the 
history  of  medicine  is  this:  When  Almansur,  the  Caliph 
of  Bagdad  (712  to  775  A.  D.),  made  up  his  mind  to  introduce 
Greek  medicine  into  his  kingdom  and  looked  around  for 
the  ways  and  means  of  accomplishing  this,  he  found  at  the 
city  of  Djondisabour  men  who  were  not  only  well  versed 
in  Greek  medicine,  but  who  at  the  same  time  were  so  thor- 
oughly grounded  in  all  departments  of  scholarship  that 
they  could  at  once  begin  the  work  of  translating  the  writings 
of  Hippocrates  and  other  classical  medical  authors  into 
Arabic,  the  language  of  the  Mohammedans.  But  at  this 
stage  of  affairs  the  existence  of  a  serious  obstacle  was 
discovered.    The  writings  which  it  was  proposed  to  trans- 


THE  INFLUENCE  OF  CHRISTIANITY        185 

late  were  not  immediately  obtainable,  and  it  therefore 
became  necessary  to  institute  without  delay  a  vigorous 
search  for  the  books  required.  In  order  that  the  reader 
may  appreciate  fully  the  difficulties  which  Almansur  had 
to  overcome,  in  this  matter  of  a  scarcity  of  Greek  originals, 
it  seems  best  to  pause  at  this  point,  and  to  review  briefly 
some  of  the  facts  which  bear  upon  the  question  at  issue. 

The  Wholesale  Destruction  of  Medical  Literature  during 
the  Early  Centuries  of  the  Christian  Era. — The  invasion 
of  Eome  in  410  A.  D.  was  one  of  the  first  events  which 
entailed  a  serious  loss  of  the  Greek  medical  books  that  had 
been  accumulating  for  several  centuries  in  that  city.  Fortu- 
nately, not  a  few  of  these  works  were  rescued  in  time  by 
the  church  authorities  and  deposited  for  safe  keeping  in 
the  various  monasteries  scattered  all  over  the  Roman 
Empire.  A  still  more  serious  destruction  of  books  occurred 
about  the  year  638  A.  D.,  when  Amrou,  a  famous  Arabian 
warrior,  captured  Alexandria  and — under  the  instructions 
of  his  master,  Omar  ben  Khattab — destroyed  the  greater 
part  of  the  contents  of  the  famous  libraries  located  in  that 
city.  The  narrative  of  this  event,  as  told  by  Lucien 
Le  Clerc,  is  as  follows: — 

John  the  Grammarian,^  who  was  living  at  that  time  in  Alex- 
andria, held  the  following  conversation  with  Amrou  on  a  certain 
occasion :  * '  You  have  inspected  all  the  edifices  of  Alexandria,  and 
have  sequestrated  all  their  contents.  I  have  no  objections  to  your 
appropriating  everything  that  may  be  of  use  to  you;  there  are 
certain  things,  however,  which  you  may  not  wish  to  possess,  but 
which  are  highly  prized  by  us. ' ' 

"What  are  those  objects?"  inquired  Amrou. 

1  John  the  Grammarian,  whose  nativity  is  not  stated  by  Le  Clerc,  was  at 
first  a  simple  boatman  who  ferried  back  and  forth  those  who  attended  a  school 
which  was  located  on  one  of  the  islands  at  Alexandria.  As  a  result  of  his 
frequent  talks  with  these  men,  he  became  enamored  with  philosophy  and 
decided,  notwithstanding  his  age  (forty  years),  to  devote  himself  entirely 
to  the  study  of  the  subject.  Accordingly,  he  sold  his  boat  and  attended  the 
lectures  regularly,  becoming  at  last  an  expert  in  philosophy.  He  wrote  several 
important  treatises  and  commentaries,  some  of  them  dealing  with  medical 
topics,  and  he  also  made  a  number  of  translations  from  the  Greek  into  Arabic. 


186  GROWTH  OF  MEDICINE 

''The  works  on  philosophy,  which  are  contained  in  the  public 
libraries,"  John  replied. 

"I  can  do  nothing  about  them  without  a  special  order  from  the 
Prince  of  Believers,  Omar  ben  Khattab,"  was  the  answer  given 
by  Amrou. 

John's  wish  having  in  the  meantime  been  conveyed  by  the 
General  to  Omar,  the  latter  sent  this  reply : — 

"As  to  the  books  of  which  you  speak,  I  have  this  to  say.  If  their 
contents  agree  with  what  is  written  in  the  word  of  God,  the  books 
are  of  no  use  to  us,  the  Holy  Writ  being  sufficient  for  our  guidance. 
But  if  they  are  at  variance  with  God's  word,  then  surely  they 
should  be  destroyed." 

Amrou  therefore  ordered  all  the  books  to  be  sent  to  the  bathing 
establishments  of  Alexandria,  to  be  used  as  fuel  in  heating  the 
baths.  So  great  was  the  number  of  books  contained  in  the  libraries 
that  it  took  six  months  to  consume  them  all.  (Sismondi  questions 
the  correctness  of  this  account.) 

While  the  invasion  of  Rome  by  the  Barbarians  in  the 
fifth  century  and  the  capture  of  Alexandria  by  the  Arabs 
in  the  early  part  of  the  seventh  gave  rise  to  an  enormous 
loss  of  valuable  books  relating  to  medicine  and  philosophy 
in  general,  these  were  by  no  means  the  only  occasions  when 
books  were  probably  destroyed  in  great  quantities.  Wars 
were  frequent  in  those  days  and  towns  were  constantly 
being  sacked.  Everywhere  throughout  the  East  the  modern 
traveler  encounters  the  ruins  of  large  cities,  and  in  those 
cities — the  centres,  as  they  were,  of  wealth  and  culture — 
there  must  have  been  large  collections  of  books.  It  is  not 
at  all  strange,  therefore,  that  when  the  Caliph  Almansur 
made  a  serious  beginning  of  the  work  which  was  to  convert 
the  Arabs  into  rivals  of  the  ancient  Greeks,  he  should  have 
found  a  great  scarcity  of  medical  works  which,  after  being 
translated,  were  to  serve  as  manuals  of  instruction.  How- 
ever, his  ambition  was  very  great,  his  wealth  almost 
inexhaustible,  and  his  associates  eager  to  aid  him  in 
realizing  the  renaissance  which  he  had  planned  for  his 
people ;  and,  as  will  appear  later  on,  he  and  those  who  aided 
him  eventually  succeeded  in  overcoming  this  apparently 
insurmountable  obstacle. 


TEE  INFLUENCE  OF  CHRISTIANITY        187 

Among  the  medical  books  which,  upon  the  approach  of 
the  Goths,  were  carried  from  Eome  and  other  cities  to 
different  monasteries  for  safe  keeping  there  must  have 
been  very  few  that  were  written  in  Latin,  and  yet  these 
were  the  only  ones  from  which  the  monks  individually 
could  derive  any  benefit.  Several  centuries  later,  when  all 
the  monasteries  of  Italy  and  the  East  were  visited  by  those 
who  were  searching  eagerly  for  original  manuscript-copies 
of  the  Greek  medical  writers, — Hippocrates,  Soranus, 
Eufus  of  Ephesus,  Aretaeus,  Dioscorides,  Galen, — it  was 
found  that  such  copies  existed  in  a  number  of  these  insti- 
tutions, thus  showing  that  the  monks  had  been  actuated 
by  unselfish  and  far-seeing  loyalty  to  the  best  interests  of 
mankind  when  they  rescued  these  particular  treasures 
from  the  hands  of  the  enemy.  They  themselves  could  make 
no  use  of  them,  being  unable  to  read  Greek,  but  they  knew 
their  priceless  value  to  medical  science. 

The  Latin  treatises  which  they  had  also  rescued,  and  of 
which  they  made  excellent  use  during  the  succeeding  cen- 
turies, were  those  of  Celsus,  Scribonius  Largus,  Pliny  the 
Elder  (to  a  slight  degree  only)  and  Caelius  Aurelianus. 


%\ 


/r1 


PART  II 
MEDIAEVAL  MEDICINE 


I'll 


CHAPTER  XVII 

THE  CONDITION  OF  MEDICINE  AT  BYZANTIUM 
DURING  THE  EARLY  PART  OF  THE  MIDDLE 
AGES 

The  Byzantine  period  of  the  history  of  medicine  begins 
about  the  middle  of  the  fourth  century  A.  D.  and  retains 
some  degree  of  importance  up  to  or  perhaps  a  little  beyond 
the  beginning  of  the  eighth  century.  During  this  period 
of  nearly  four  centuries  there  appeared  on  the  scene 
five  physicians  whose  writings  form  a  very  creditable 
part  of  the  late  Greek  medical  literature.  The  names  of 
these  authors  are :  Oribasius,  Aetius,  Alexander  of  Tralles, 
Theodore  Priscianus  and  Paulus  Aegineta. 

Oribasius. — The  first  physician .  named  in  this  list, 
Oribasius,  was  born  about  the  year  325  A.  D.  in  Pergamum, 
an  important  city  of  Asia  Minor  and  the  birthplace  of 
Galen.  He  received  his  medical  training  at  Alexandria, 
settled  in  Constantinople  (the  new  name  given  to  Byzan- 
tium), and  soon  afterward  became  the  personal  physician 
of  the  Emperor  Julian  the  Apostate,  the  nephew  of 
Constantine  the  Great.  Subsequently  he  was  appointed 
Quaestor  of  Constantinople,  but,  upon  the  death  of  Julian 
(363  A.  D.)  and  the  accession  of  Valens  and  Valentinianus 
to  power,  his  property  was  confiscated  and  he  himself  was 
obliged  to  take  refuge  among  the  Ostrogoths,  who  dwelt 
on  the  shores  of  the  Black  Sea.  These  people  received 
him  with  open  arms,  and  he  soon  acquired  great  influence 
among  them.  After  a  time,  however,  he  was  recalled  to 
Constantinople  and  all  his  former  privileges  were  once 
more  granted  to  him.    He  died  about  the  year  403  A.  D. 


192  GROWTH  OF  MEDICINE 

Despite  his  duties  as  a  practicing  physician  of  the  very 
highest  rank — duties  which  he  could  not  wholly  set  aside 
when  he  accepted  the  office  of  Quaestor  of  Constantinople — 
and  despite  the  necessity  of  devoting  considerable  time  to 
the  work  which  this  non-medical  official  position  entailed, 
Oribasius,  like  Pliny,  appears  to  have  been  a  most  energetic 
contributor  to  medical  literature.  We  possess  to-day,  for 
example,  a  large  part  of  the  medical  cyclopaedia  (72 
books)  which  he  prepared  at  the  command  of  the  Emperor 
Julian,  and  which — even  in  its  incomplete  state — contains 
very  full  information  regarding  anatomy,  physiology, 
surgery,  pathology  and  pharmacology.  Although  the  work 
is  simply  a  compilation,  its  present  value  is  great,  for  it 
contains  numerous  extracts  from  earlier  and  contemporary 
treatises,  many  of  which  have  entirely  disappeared, — 
treatises  of  which  we  should  have  had  no  knowledge  what- 
ever if  Oribasius  had  not  introduced  numerous  extracts 
from  them  into  his  cyclopaedia. 

About  the  year  390  A.  D.,  when  Oribasius  was  already  an 
old  man,  he  published  (in  nine  books)  a  "Synopsis"  of  the 
larger  work,  chiefly  for  the  benefit  of  his  son  Eustathios, 
who  was  at  that  time  studying  medicine.  Surgery  is 
omitted  from  this  work,  as  that  branch  of  medicine  was 
assumed  to  belong  entirely  to  specialists.  At  a  still  later 
date  (about  395  A.  D.),  Oribasius  published  a  third  work 
(in  four  books)  entitled  "Euporista,"  which  was  intended 
chiefly  for  the  use  of  laymen.  The  subject-matter  of  this 
treatise  consists  of  diet,  hygiene  and  general  therapeutics. 
Neuburger  speaks  well  of  all  three  of  the  published  works 
of  Oribasius,  and  furnishes  a  fairly  full  analysis  of  the 
contents  of  each  one. 

Bussemaker  and  Daremberg  have  published,  in  six 
volumes  (Paris,  1856-1876),  an  excellent  French  version 
of  the  works  of  Oribasius. 

Priscianus. — Theodorus  Priscianus  lived  during  the 
latter  part  of  the  fourth  and  the  first  part  of  the  fifth  cen- 
tury of  the  present  era.  Very  little  is  known  about  his 
professional  career  beyond  the  facts  that  he  was  a  pupil 
of  Vindicianus,  a  distinguished  physician  who  lived  during 


MEDICINE  IN  THE  MIDDLE  AGES  193 

the  reign  of  the  Emperor  Valentinianus  I.  at  Constanti- 
nople (364-375  A.  D.),  and  that  subsequently  he  was  chosen 
the  private  physician  of  the  Emperor  Gratianus  (375-383 
A.  D.).  The  treatise  which  he  composed,  and  which  bore 
the  title  of  '  *  Euporiston, ' '  was  originally  written  in  Greek, 
but  was  afterward  translated  by  its  author  into  Latin.  An 
excellent  German  version  of  the  work  by  Meyer-Steineg 
was  published  in  Jena  in  1909.  As  the  book  was  intended 
by  Priscianus  to  serve  chiefly  as  a  guide  to  practitioners 
of  the  art,  it  contains  practically  nothing  about  anatomy 
and  physiology.  In  his  pathology  he  follows  closely  the 
teachings  of  the  Methodists;  his  first  question,  in  the 
presence  of  a  case  of  illness,  being:  **Do  the  symptoms 
point  to  a  condition  of  strictum  rather  than  to  one  of  laxum, 
or  vice  versa? ^^  **In  his  treatment,"  says  Meyer-Steineg, 
'*  Priscianus  follows  very  closely  the  rule  that  every 
patient,  no  matter  what  may  be  the  disease  with  which  he 
is  affected,  should  first  undergo  a  certain  amount  of  general 
treatment."  In  his  choice  of  remedies  Priscianus  inva- 
riably gives  the  preference  to  those  agents  which  are  of 
a  simple  character  and  easy  to  obtain.  On  the  other  hand, 
he  does  not  hesitate  to  admit  that  he  sometimes  employs 
certain  magical  remedies,  as  is  shown  by  the  following 
quotation  taken  from  Book  IV.,  Chapter  I.,  section  4: — 

If  a  person  wears,  during  the  waning  of  the  moon,  a  wreath  of 
polygonum  on  his  head,  he  will  obtain  relief  from  his  headache. 

If  one  drinks  of  the  water  from  which  an  ox  has  just 

drank,  he  will  be  relieved  of  the  pain  in  his  head If  a 

loadstone  be  held  upon  the  head  it  will  draw  out  the  hidden  pain, 
and  the  same  effect  may  be  obtained  by  rubbing  over  the  forehead 
a  swallow's  nest  thoroughly  mixed  with  vinegar. 

In  Book  I.,  paragraph  2,  Priscianus  draws  a  picture  of 
the  rude  and  uncivilized  behavior  of  the  practitioners  of 
his  day  in  the  sick-room.  The  following  are  his  words  as 
translated  from  the  German  of  Meyer-Steineg : — 

As  the  patient  lies  on  his  bed  prostrated  by  the  severity  of  the 
disease,  there  quickly  comes  into  the  room  a  crowd  of  us  physi- 
cians.   No  feeling  of  sympathy  for  the  sick  man  have  we,  nor  do 


194  GROWTH  OF  MEDICINE 

we  realize  how  impotent  we  all  are  in  the  presence  of  these  forces 
of  nature.  Instead,  we  struggle  to  the  utmost  of  our  ability  to 
obtain  charge  of  the  case ;  one  depending  for  success  on  his  powers 
of  persuasion,  a  second  on  the  strength  of  the  arguments  which 
he  is  able  to  bring  forward,  a  third  on  his  readiness  to  agree  with 
everything  that  is  said,  and  the  fourth  on  his  skill  in  contradicting 
the  opinion  of  everybody  else.  And,  as  this  quarrel  goes  on,  the 
patient  continues  to  lie  there  in  a  state  of  exhaustion.  "For 
shame!"  Nature  seems  to  say,  "you  men  are  an  ungrateful  lot! 
You  do  not  even  permit  the  patient  to  die  quietly ;  you  simply  kill 
him.  And  then,  moreover,  you  accuse  me  of  not  furnishing  suffi- 
cient means  of  effecting  a  cure.  Illness  is  certainly  a  painful 
affair,  but  I  have  provided  plenty  of  remedies.  Poisons,  I  admit, 
are  hidden  in  some  of  the  plants,  but  the  healing  agents  which  may 
be  extracted  from  them  are  much  more  numerous.  Away,  then, 
with  your  angry  disputes  and  your  self-glorifying  chatter;  for 
in  these  are  not  to  be  found  the  remedial  agents  which  I  have 
bestowed  upon  man,  but  rather  in  the  powerful  forces  which  reside 
in  the  seeds,  fruits,  plants  and  other  objects  which  I  have  created 
in  his  interests." 

Aetius. — Aetius  was  a  native  of  Amida,  in  Mesopotamia, 
and  he  lived  during  the  early  part  of  the  sixth  century 
A.  D.,  under  the  Emperor  Justinian  I.  He  studied  medicine 
at  Alexandria  and  then  settled  in  Constantinople,  where 
he  was  appointed  to  the  double  office  of  private  physician 
to  the  emperor  and  commanding  officer  of  his  body-guard 
{Comes  obsequii), — an  arrangement  which  made  it  prac- 
ticable for  the  emperor  to  have  his  physician  near  his 
person  on  all  possible  occasions.  Almost  nothing  is  known 
about  the  subsequent  private  life  and  professional  career 
of  Aetius  beyond  the  facts  that  he  was  a  Christian  and  that 
he  wrote  a  treatise  on  medicine  in  sixteen  books,  which 
together  form  a  large  volume.  The  work,  says  Le  Clerc, 
is  almost  entirely  a  compilation  from  the  treatises  of 
earlier  writers  on  medicine  and  surgery;  the  best  parts  of 
the  book  being  those  which  relate  to  the  pathology  and 
treatment  of  internal  diseases,  to  materia  medica,  and  to 
ophthalmology.  The  Christianity  of  Aetius,  like  that  of 
Alexander  of  Tralles,  and  other  physicians  of  a  later 
period,   appears   to   have  permitted  a  belief  in  magical 


MEDICINE  IN  THE  MIDDLE  AGES  195 

remedies.  For  example,  Aetius  gives  formulae  containing 
the  names  of  the  Saviour  and  the  Holy  Martyrs  for 
exorcising  certain  maladies,  and  he  recommends  the 
employment  of  amulets.  The  subject  of  baths  is  treated 
by  him  quite  thoroughly,  and  he  lays  stress  upon  the 
importance  of  physical  exercise  as  a  means  of  maintaining 
one's  health.  Freind,  the  author  of  an  English  history  of 
medicine  which  was  very  popular  in  its  day,^  quotes  the 
following  remedy  for  gout  from  the  treatise  of  Aetius: — 

In  September  to  drink  milk; 
in  October  to  eat  garlick; 
in  November  to  abstain  from  bathing ; 
in  December  not  to  eat  cabbage ; 

in  January  to  take  a  glass  of  pure  wine  in  the  morning ; 
in  February  to  eat  no  beet ; 

in  March  to  mix  sweet  things  both  in  eatables  and  drinkables ; 
in  April  not  to  eat  horseradish ; 
nor  in  May  the  fish  called  Polypus ; 

in  June  to  drink  cold  water ; — and  so  on  through  the  remainder  of 
the  year. 

At  the  end  of  the  French  version  of  ^^Les  Oeuvres  de 
Rufus  d'  iSphese"  (translated  from  the  Greek  by  Darem- 
berg  and  Ruelle)  will  be  found  fragments  of  some  of  the 
books  of  Aetius;  in  1899  J.  Hirschberg  translated  into 
German  Book  VII.  (eye  diseases)  of  the  same  author;  and, 
two  years  later  (1901)  Max  Wegscheider  published  a 
German  version  of  Book  XVI.  (obstetrics  and  gynaecology). 
No  other  translations  of  the  writings  of  Aetius  into  either 
French,  German  or  English  are — so  far  as  I  am  able  to 
learn — available. 

Alexander  of  Tralles. — Alexander  of  Tralles,  a  city  of 
Lydia,  in  Asia  Minor,  was  bom  about  525  A.  D.  His 
father  Stephanus  was  highly  esteemed  as  a  practicing 
physician,  and  his  four  brothers,  all  of  them  older  than 
himself,  were  men  of  distinction  in  their  several  callings; 
Anthemius,  the  oldest,  being  one  of  the  greatest  mathe- 
maticians and  mechanicians  of  his  day  and  the  man  to 

1  Third  edition,  London,  1726. 


196  GROWTH  OF  MEDICINE 

whom  the  Emperor  Justinian  intrusted  the  rebuilding  of 
the  church  of  St.  Sophia  in  Constantinople;^  Metrodorus, 
a  celebrated  grammarian  and  the  honored  teacher  of  the 
youth  belonging  to  the  highest  circles  of  that  metropolis; 
Olympius,  a  leading  authority  in  jurisprudence;  and 
Dioscorus,  a  prominent  physician  in  his  native  city. 
Alexander  received  his  first  instruction  in  medicine  from 
his  father,  but  he  obtained  his  real  training  from  a  physi- 
cian who  was  the  father  of  his  most  intimate  friend  Cosmas, 
and  who,  throughout  Alexander's  entire  subsequent  career, 
proved  most  helpful  in  advancing  his  interests.  At  first 
he  traveled  extensively,  visiting  in  succession — probably 
in  the  capacity  of  a  military  surgeon — Italy,  Northern 
Africa,  Gaul  and  Spain.  Afterward,  he  settled  perma- 
nently at  Rome  and  practiced  medicine  there  during  the 
remainder  of  a  long  life.  Puschmann,  the  translator  of 
his  writings,  seems  disposed  to  believe  that  he  was  both 
a  teacher  and  a  practitioner  of  medicine  during  his  resi- 
dence in  that  city.  When  he  became  too  old  to  bear  the 
heavy  burdens  of  medical  practice,  he  wrote  an  account  of 
his  life, — a  life  which  was  rich  in  professional  experience, — 
and  thus  built  for  himself  **a  monument  more  striking  and 
more  durable  than  the  splendid  temple  erected  by  his  eldest 
brother."    (Meyer,  quoted  by  Puschmann.) 

Various  circumstances  justify  the  conclusion  that  Alex- 
ander of  Tralles  was  a  Christian.  His  style  of  writing 
is  simple  and  direct,  and  he  states  his  views  with  a  degree 
of  modesty  which  wins  for  him  at  once  the  sympathy  and 
confidence  of  his  readers.  He  gives  full  and  generous 
recognition  to  the  great  physicians  who  lived  and  wrote 
before  his  time,  and  more  especially  to  Hippocrates.  On 
the  other  hand,  he  does  not  hesitate,  when  he  believes  that 
he  is  right,  to  put  forward  views  which  are  in  direct 
antagonism  with  those  of  even  so  great  an  authority  as 
Galen.  In  the  domain  of  therapeutics,  says  Puschmann, 
Alexander  was  decidedly  superior  to  Galen.    His  teachings 

2  Anthemius  is  also  credited  with  beiag  the  inventor  of  the  principle  of 
dome  construction  in  architecture. 


MEDICINE  IN  THE  MIDDLE  AGES  197 

are  based  on  experience  gained  in  actual  practice,  whereas 
Galen  was  very  often  disposed  to  trust  to  considerations 
of  a  theoretical  nature;  for  he  was  chiefly  interested  in 
establishing  the  pathology  of  the  different  diseases  and  in 
opening  up  new  territories  in  medicine  in  which  the  human 
mind  might  display  its  activity. 

The  twelve  books  of  which  the  treatise  of  Alexander  of 
Tralles  consists,  were  printed  in  the  original  Greek  for 
the  first  time  in  1548,  by  Eobert  ^fitienne,  the  celebrated 
printer  of  Francis  L,  King  of  France.  The  last  and  most 
perfect  edition  of  the  Greek  text  is  that  of  the  late  Dr. 
Theodore  Puschmann,  which  was  published  in  Vienna  in 
1878  (two  Vols.).  It  contains,  in  addition  to  the  Greek 
version,  a  careful  analysis  of  the  twelve  individual  books, 
and  an  admirable  German  translation  of  the  entire  work. 
It  is  from  the  latter  that  the  following  brief  extracts 
(translated  into  English)  are  taken: — 

Introduction  to  the  writings  of  Alexander  of  Tralles. — Upon 
a  certain  occasion,  my  dearest  Cosmas,  thou  didst  urge  me  to 
publish  my  rich  experiences  in  the  domain  of  practical  medicine, 
and  I  am  now  gladly  complying  with  thy  wish,  for  I  feel  under 
deep  obligations  to  both  thyself  and  thy  father  for  the  kindness 
which  you  have  shown  to  me  on  every  possible  occasion  in  the  past. 
Thy  father  was  always  a  most  helpful  patron  to  me,  not  only  in 
my  practice,  but  also  in  all  other  relations  of  life.  And  thou  also, 
even  when  thou  wert  living  abroad,  stood  staunchly  by  me  through 
all  the  trials  which  I  experienced  and  the  severe  blows  dealt  me  by 
Fate.  For  these  reasons  I  will  now  in  my  old  age,  when  it  is  no 
longer  possible  for  me  to  endure  the  labor  and  worries  of  practice, 
do  as  thou  desirest,  and  will  write  a  book  in  which  shall  be  set 
forth  the  experience  which  I  have  gained  during  my  long  service 
in  the  treatment  of  disease.  I  hope  that  many  of  those  who  read 
what  is  here  written,  with  minds  free  from  jealousy,  will  experience 
real  pleasure  in  noting  the  well-founded  and  scientific  character 
of  the  rules  which  I  have  laid  down  and  the  brevity  and  preciseness 
of  my  descriptions.  For  I  have  done  my  very  best  always  to 
employ  simple  words,  in  order  that  everybody  may  find  it  easy 
to  understand  my  book. 

Some  Magical  Remedies  or  Amulets  Recommended  hy  Alex- 
ander of  Tralles,  as  Effective  in  the  Treatment  of  Colic. — The 


198  GROWTH  OF  MEDICINE 

Thracians  remove  the  heart  from  a  lark  while  the  bird  is  still  alive, 
and  wear  it,  prepared  as  an  amulet,  on  the  left  thigh. 

Procure  a  little  of  the  dung  of  a  wolf,  preferably  some  which 
contains  small  bits  of  bone,  and  pack  it  in  a  tube  which  the  patient 
may  easily  wear  as  an  amulet  on  his  right  arm,  thigh,  or  hip  during 
the  attack.  He  must  be  very  careful,  however,  not  to  allow  the 
parts  around  the  seat  of  the  pain  to  come  in  contact  with  the  earth 
or  with  the  water  of  a  bath.  This  amulet  is,  in  my  experience,  an 
unfailing  remedy,  and  almost  all  physicians  of  any  celebrity  have 
commended  its  virtues. 

Remove  the  nipple-like  projection  from  the  caecum  of  a  young 
pig,  mix  myrrh  with  it,  wrap  it  in  the  skin  of  a  wolf  or  dog,  and 
instruct  the  patient  to  wear  it  as  an  amulet  during  the  waning  of 
the  moon.    Striking  effects  may  be  looked  for  from  this  remedy. 

Let  the  design  of  Hercules  throttling  a  lion  be  engraved  upon 
a  Median  stone,  and  then  instruct  the  patient  to  wear  it  on  his 
finger  after  it  has  been  properly  set  in  a  ring  of  gold. 

Take  an  iron  ring  and  have  the  hoop  made  eight-sided.  Then 
engrave  upon  the  eighth  side  these  words:  "Flee,  flee,  oh  Gaul! 
the  lark  has  sought  thee  out."  On  the  under  surface  of  the 
head  or  seal  of  the  ring  engrave  the  letters  J.  C,  thus: 
I  have  often  made  use  of  this  amulet;  and,  while  I  should 
consider  it  wrong  to  keep  silence  about  a  remedial  agent  of 
such  extraordinary  efficacy  in  cases  of  colic,  I  feel  bound  to  say 
that  it  should  not  be  recommended  to  the  first  comer,  but  only  to 
believers  and  to  those  individuals  who  know  how  to  guard  it 
carefully.  The  Great  Hippocrates,  with  remarkable  insight,  gave 
the  advice  that  things  which  are  holy  should  be  intrusted  only  to 
those  who  are  of  a  religious  character,  and  should  be  withheld  from 
the  profane.  As  regards  the  ring,  however,  the  patient  must  be 
careful,  before  wearing  it,  to  have  a  sketch  made  of  it  on  either 
the  seventeenth  or  the  twenty-first  day  of  the  moon. 

Alexander  has  been  severely  criticised  for  his  advocacy 
of  the  employment  of  amulets  in  the  treatment  of  diseases ; 
but  he  defends  himself  against  such  criticism  by  saying  that 
physicians  owe  it  as  a  duty  to  their  patients  to  study  care- 
fully what  he  calls  the  hidden  forces  of  nature,  and  to  pay 
unprejudiced  attention  to  the  effects  produced  by  amulets 
and  other  magical  remedies.  He  reminds  his  critics  that 
Galen  and  other  eminent  medical  authorities  have  insisted 
that  a  place  be  given  to  this  class  of  agents  in  the  list  of 


MEDICINE  IN  THE  MIDDLE  AGES  199 

authorized  remedies;  and  lie  adds  that  Galen  further 
emphasizes  the  duty  of  the  physician  to  employ  them  when 
other  measures  fail,  or  when  the  patients  themselves 
frankly  confess  that  they  have  faith  in  their  efficacy  and 
therefore  wish  them  to  be  tried.  Alexander  also  makes  the 
statement  that  Galen,  after  treating  for  a  long  time  all 
reports  about  the  beneficial  results  obtained  from  the 
employment  of  magical  measures  as  old  women 's  tales,  had 
finally  decided  that  these  benefits  were  at  times  marvelous 
and  should  be  accepted  as  genuine  by  physicians  even  if 
they  are  unable  to  explain  them. 

How  much  Alexander  of  Tralles  really  believed  in  these 
supernatural  agents,  or  to  what  extent  he  relied  upon  their 
effect  in  influencing  the  imagination,  we  may  not  know; 
but  his  was  an  age  of  superstition,  and  the  conditions 
governing  society  at  that  time  were  very  different  from 
those  which  control  the  world  at  the  present  day. 

Paulus  Aegineta. — Paulus  Aegineta^  was  born  in  the 
Island  of  Aegina,  not  far  from  Athens,  in  the  early  part  of 
the  seventh  century  A.  D.,  and  practiced  medicine  in 
Alexandria,  Egypt.  He  is  known  to  us  as  the  author  of  a 
compend  of  medicine  which  was  very  popular  during  a  long 
period  of  time,  especially  among  the  Arabs,  who,  as  early 
as  two  hundred  years  after  his  death,  translated  his  work 
from  the  Greek  into  their  own  language.  At  a  still  later 
period  it  was  also  translated  into  Latin,  the  two  best  ver- 
sions in  this  language  which  we  now  possess  being  those 
of  Guintherus  Andernacus  (Paris,  1532)  and  of  J.  Cor- 
narius  (Basel,  1556).  There  is  also  an  English  translation 
by  F.  Adams  (''The  Seven  Books  of  Paulus  Aegineta,*' 
London,  1845-1847),  which  is  favorably  spoken  of  by 
Neuburger,  and  which  is  apparently  at  the  present  time 
the  only  existing  version  of  the  work  of  Paulus  of  Aegina  in 
a  modern  European  language;  for  the  French  translation 
by  Rene  Brian  (''La  Chirurgie  de  Paul  d'J^gine/'  Paris, 
1855)  comprises  only  Book  VI. 

The  contents  of  the  entire  work  are  as  follows: 
Book  I. — Dietetics  of  Pregnant  Women  and  of  Children; 

8  Also  written  Paulus  Aeginetes. 


200  GROWTH  OF  MEDICINE 

Children's  Diseases;  Massage,  Gymnastics,  Sexual  Hy- 
giene, Bathing,  etc.;  Booh  //.^General  Pathology,  the 
Doctrine  of  Fevers,  Semeiology;  Booh  III. — Diseases  of 
the  Hair,  Diseases  of  the  Brain  and  Nerves,  Diseases  of  the 
Eyes,  Ears,  Nose,  Mouth,  Teeth  and  Face;  Booh  IV. — 
Leprosy,  Skin  Diseases,  ^fnflammations.  Swellings,  Tumors, 
Wounds,  Ulcers,  Fistulae,  Hemorrhage,  Worms,  Affections 
of  the  Joints,  etc.;  Booh  V. — Toxicology;  Booh  VI. — Sur- 
gery; Booh  VII. — Materia  Medica. 

To  furnish  even  a  very  superficial  analysis  of  the  contents 
of  this  treatise  would  call  for  more  space  than  can  well 
be  given  up  here  to  such  a  purpose.  I  shall  therefore 
simply  mention  a  few  points  of  special  interest  to  which 
Neuburger  calls  attention  in  the  course  of  his  very  full 
analysis  of  the  work.  He  states,  for  example,  that  Paulus 
mentions  several  instances  in  which  patients  affected  with 
lung  disease,  coughed  up  calculi  or  small  stone-like  masses. 
He  also  states  that  the  same  author  was  familiar  with  the 
fact  that  in  the  course  of  ''phthisis,"  the  pus  may  find  its 
way  into  the  bladder  and  there  cause  ulceration  [in  other 
words,  that  pus  containing  tubercle  baccilli  may  flow  down 
by  way  of  the  ureters  and  cause  tuberculous  ulceration  of 
the  bladder].  Paulus'  theory  regarding  the  origin  of  gout, 
adds  Neuburger,  is  quite  remarkable  for  that  early  period. 
He  maintains,  for  example,  that  in  persons  who  lead  a 
rather  inactive  life  and  who  are  often  affected  with 
digestive  disorders,  there  is  produced,  through  the  inade- 
quate power  of  the  tissues  of  the  body  to  assimilate  the 
excess  of  nutriment  brought  to  them,  a  materies  morbi 
which  is  drawn  first  to  the  parts  that  a're  weakest  or  least 
capable  of  resistance  (the  joints,  for  example)  and  then 
also  to  other  structures,  as  the  liver,  spleen,  throat,  ears 
and  teeth.  These  ideas — let  it  be  remembered — ^were  set 
down  in  writing  in  650  A.  D. 

At  the  beginning  of  his  analysis  of  Book  VI.,  Neuburger 
makes  this  remark:  ''Although  the  description  given  by 
Paulus  of  the  surgery  of  the  ancients  is  based  upon  the 
writings  of  Hippocrates  and  Galen,  as  well  as  upon  those 
of  Leonides,  Soranus  and  Antyllus,  one  finds  at  every  step 


MEDICINE  IN  THE  MIDDLE  AGES  201 

ample  evidence  that  the  writer  possessed  both  independence 
of  judgment  and  the  manual  skill  which  belongs  to  a  physi- 
cian who  is  familiar  with  surgical  work."  He  calls  par- 
ticular attention  to  the  section  (No.  88)  which  deals  with 
the  manner  of  removing  the  heads  of  arrows  from  wounds, 
and  he  gives  special  praise  to  Paulus  for  his  most  instruc- 
tive account  of  the  diagnostic  signs  to  be  looked  for  in  a 
case  of  suspected  wounding  of  a  vital  organ.  He  is 
extremely  thorough,  says  Neuburger,  in  his  teachings 
about  fractures  and  dislocations,  and  he  not  infrequently 
differs  from  the  views  expressed  by  his  predecessors. 

In  the  section  devoted  to  gynaecological  operations 
Paulus  makes  it  perfectly  clear  that  he  was  in  the  habit 
of  using  a  speculum  of  a  very  practical  form.  Here  are 
his  words: — 

and,  while  the  operator  is  holding  the  instrument  in  posi- 
tion, an  assistant  turns  the  screw  until  the  blades  of  the  instrument 
have  been  separated  to  the  distance  desired. 

In  other  chapters  of  Book  VI.,  Paulus  furnishes  most 
interesting  and  minute  descriptions  of  a  great  variety  of 
operations  in  general  surgery  and  also  in  obstetrics, 
ophthalmology,  otology  and  rhinology.  Those  who  desire 
to  learn  further  details  about  these  surgical  matters  should 
consult  the  English  version  mentioned  on  a  previous  page. 

It  is  not  at  all  unlikely  that  at  some  future  day  it  will 
be  found  desirable — by  reason  of  the  discovery  of  the 
treatises  which  they  are  known  to  have  written,  but  which 
have  been  lost — to  add  to  this  short  list  of  ancient  medical 
authors  the  names  of  the  following  men  who  are  frequently 
quoted  by  them  in  their  works:  Antyllus,  who  made  some 
really  valuable  additions  to  our  knowledge  of  the  proper 
manner  of  treating  aneurysms,  and  who  must  have  been  a 
surgeon  of  great  resourcefulness;  Leonides,  the  Alexan- 
drian, who  lived  about  the  time  of  Galen,  and  who  appears 
to  have  been  highly  considered  for  his  practical  common 
sense  in  the  choice  of  surgical  measures;  Hesychios  of 
Byzantium  and  his  distinguished  son.  Jacobus  Psy- 
chrestus,  who  was  highly  spoken  of  by  his  contemporaries 


202  GROWTH  OF  MEDICINE 

(fifth  century  A.  D.),  in  whose  honor  a  public  statue  was 
erected  (Haller),  and  to  whom  is  attributed  the  saying: 
*  *  A  good  physician  should  either  decline  at  the  start  to  take 
charge  of  a  patient,  or  else  he  should  not  leave  him  until 
he  shall  have  brought  about  some  measure  of  improve- 
ment"; finally,  Heliodorus,  and  perhaps  a  few  others  who 
are  less  well  known. 


CHAPTER  XVIII 

BEGINNING  OF  THE  ARAB  RENAISSANCE  UNDER 
THE  CALIPHS  OF  BAGDAD 

Toward  the  end  of  the  sixth  century  A.  D.  the  prospects 
for  the  perpetuation  and  further  evolution  of  Greek  medi- 
cine looked  decidedly  dark.  In  Rome  and  in  the  larger 
Italian  towns  of  the  Roman  Empire,  physicians  were 
doubtless  still  to  be  found,  but  they  must  have  led  very 
precarious  lives  and  they  certainly  could  not  have  had  any 
leisure  or  opportunity  for  scientific  work.  In  these  earlier 
years  of  the  Middle  Ages  the  monks  conducted  the  larger 
part  of  whatever  medical  practice  was  required  in  the 
districts  in  which  the  monasteries  were  located.  In 
Byzantium,  also,  the  outlook  at  this  period  of  Roman  his- 
tory was  very  unfavorable ;  and  nowhere  else,  as  a  matter 
of  fact,  would  it  have  been  possible  for  the  casual  observer 
to  discover  any  signs  that  indicated  the  approach  of  a 
revival  in  the  study  of  the  sciences.  And  yet,  even  at  that 
seemingly  darkest  moment  in  the  history  of  medicine,  there 
were  forces  at  work  which  would  soon  revive  these  precious 
seeds  of  Greek  knowledge,  and,  after  transplanting  them 
to  a  richer  soil,  cause  them  to  produce  even  better  fruit 
and  in  larger  quantities  than  ever  before. 

The  rulers  under  whose  auspices  the  first  steps  in  the 
great  Arab  Renaissance  were  taken,  belonged  to  what  is 
known  as  the  Abbaside  Dynasty,  the  founder  of  which  was 
Abbas  (566-652  A.  D.),  the  uncle  of  Mohammed.  His 
descendants  ruled  as  Caliphs  of  Bagdad,  on  the  eastern 
bank  of  the  Tigris,  for  many  centuries  (from  750  A.  D. 
onward).^    Almansur,  the  second  Caliph  of  this  dynasty, 

1  The  account  which  is  given  in  this  and  the  following  chapters  is  based 
largely  on  Dr.  Lucien  Le  Clerc's  Histoire  de  la  Medecine  Arabe,  Paris,  1876. 


204  GROWTH  OF  MEDICINE 

felt  a  very  strong  desire  that  his  people,  the  Arabs,  should 
acquire  knowledge  of  all  the  useful  branches  of  learning, 
and  more  especially  of  medicine  and  philosophy;  and 
accordingly,  as  the  Greeks  were  then  universally  admitted 
to  be  the  only  nation  which  possessed  that  knowledge,  and 
as  scarcely  any  scientific  books  written  in  the  Arabic  lan- 
guage existed  at  that  early  date,  he  directed  all  his  efforts 
to  the  finding  of  Greek  originals  and  of  the  men  qualified 
to  translate  them  into  Arabic.  Already  as  early  as  the 
sixth  century  A.  D.,  Sergius,  a  Christian  of  Ras  el  Ain,  had 
translated  a  considerable  number  of  Greek  treatises  into 
the  Syrian  tongue,  but  his  work  was  found  to  be  of  an 
inferior  character,  and  for  this  reason  could  not  be  utilized 
to  any  great  extent  in  the  present  undertaking.  Honein 
(ninth  century),  one  of  the  most  eminent  scholars  of  the 
Arabic  Renaissance,  revised  a  few  of  these  translations 
and  thus  rendered  them  of  some  service;  but  by  far  the 
larger  part  of  this  gigantic  task  of  creating  Arabic  versions 
of  the  classical  works  of  Greek  literature,  was  performed 
during  the  ninth  century,  a  period  during  which  the  reign 
of  the  Arabs  extended  from  the  Ganges  on  the  east  to  the 
Atlantic  on  the  west.  By  the  end  of  the  eighth  century  the 
work  of  translating  had  advanced  only  to  the  point  of 
producing  a  single  treatise  on  medicine  and  a  few  relating 
to  alchemy ;  but  before  the  ninth  was  completed,  the  Arabs 
had  in  their  possession,  in  the  form  of  translations,  nearly 
all  the  scientific  literature  of  Greece,  and,  more  than  this, 
they  could  boast  that  not  a  few  men  belonging  to  their  own 
nation  had  already  become  celebrated  as  scientists  of  the 
very  first  rank. 

The  medical  school  at  Djondisabour^  at  the  time  (765 
A.  D.)  when  the  Caliph  Almansur  decided  to  carry  out  the 
ambitious  scheme  which  he  had  been  meditating,  was 
jjractically  under  the  control  of  a  family  of  Nestorian 
Christians.  A  large  hospital  formed  the  nucleus  of  the 
institution  and  furnished  all  the  material  needed  for 
familiarizing  the  student  with  the  different  diseases  and 

2  Le  Clere  and  Freind  mention  both  Nishapur  and  Djondisabour  as  the  name 
of  the  capital  of  the  Province  of  Khorassan  in  northeast  Persia. 


TEE  ARAB  RENAISSANCE  205 

injuries  commonly  encountered  in  that  part  of  the  world 
and  with  the  methods  of  treatment  which,  as  long  experience 
had  shown,  offered  the  best  chances  of  affording  relief  or 
effecting  a  cure.  It  was  a  clinical  school  of  a  most  practical 
type,  and  at  the  head  of  it  was  George  Bakhtichou,  who  had 
been  recommended  to  Almansur  as  the  physician  best  fitted 
to  take  responsible  charge  of  the  new  work  which  was  then 
about  to  begin.  George  Bakhtichou  was  not  the  organizer 
of  the  school  at  Djondisabour,  but  simply  its  head  at  the 
time  of  which  I  am  now  speaking.  Medicine  had  been 
taught  there,  it  appears,  since  the  early  part  of  the  seventh 
century  A.  D.  The  languages  commonly  spoken  in  that 
town  were  the  Syrian,  the  Arabian  and  the  Persian,  and 
probably  only  a  few  persons  understood  Greek.  The 
Caliph  believed  that,  as  the  first  and  most  important  step 
in  the  new  work,  medical  text  books,  translations  of  the 
works  of  the  best  Greek  physicians,  should  be  provided  with 
as  little  loss  of  time  as  possible,  and  George  Bakhtichou 
agreed  with  this  opinion  entirely.  The  latter,  therefore, 
upon  the  urgent  invitation  of  the  Caliph,  left  the  hospital 
at  Djondisabour  in  the  charge  of  his  son,  Bakhtichou  ben 
Djordis,  and  went  to  Bagdad  in  company  with  two  of  his 
pupils,  Ibrahim  and  Issa  ben  Chalata.  He  was  well 
received  at  Court,  partly  because  he  displayed  a  readiness 
to  further  the  Caliph's  educational  plans,  and  partly  also 
because  he  was  promptly  successful  in  relieving  him  of  a 
distressing  dyspepsia.  Not  long  after  he  had  arrived  in 
Bagdad,  however,  he  was  himself  taken  ill  and  was  obliged 
to  return  to  Djondisabour.  Before  his  departure  the 
Caliph  presented  him  with  a  gift  of  10,000  pieces  of  gold. 
Issa  ben  Chalata,  one  of  the  two  pupils  whom  George 
Bakhtichou  had  brought  with  him  to  Bagdad,  was  left 
behind  to  look  after  the  Caliph's  health.  He  proved 
faithless  to  his  trust,  however;  and,  as  soon  as  it  was 
discovered  that  he  was  selling  his  supposed  influence  with 
the  Caliph,  he  was  not  only  dismissed  in  disgrace  but  all 
his  property  was  confiscated.  After  this  disagreeable 
experience  the  Caliph  did  his  best  to  induce  George  to 
return  to  Court,  but  the  latter  was  then  unable  to  travel, 


206  GROWTH  OF  MEDICINE 

owing  to  the  injuries  which  he  had  received  from  an  acci- 
dental fall.  His  pupil  Ibrahim  went  to  Bagdad  in  his 
place. 

It  is  known  that  George  Bakhtichou  personally  took  an 
active  part  in  the  work  of  translating  Greek  medical 
treatises  into  Arabic,  but  it  has  not  yet  been  ascertained 
which  books  in  particular  were  assigned  to  his  care  in  the 
distribution  of  the  different  tasks.  Ossaibiah,  the  Arabian 
historian,  makes  the  statement  that  the  work  of  translating 
Greek  medical  treatises  was  entirely  under  the  control  and 
guidance  of  George  Bakhtichou;  and  in  the  '^Continens" 
of  Rhazes  frequent  mention  is  made  of  the  latter 's  name. 
All  of  which  confirms  the  belief  that,  at  the  beginning  of 
the  Arabic  Renaissance,  George  Bakhtichou  was  in  reality 
the  head  and  front  of  the  movement,  so  far  at  least  as 
medicine  was  concerned.  When  he  became  too  old  and 
infirm  to  continue  his  attendance  at  the  Djondisabour 
hospital,  he  intrusted  the  management  of  that  institution 
to  Issa  ben  Thaherbakht,  who  was  one  of  his  best  pupils. 
He  died  in  771  A.  D. 

In  786  A.  D.,  Haroun  Alraschid  succeeded  to  the 
caliphate ;  and  not  long  afterward,  on  the  occasion  of  some 
temporary  illness,  he  requested  Bakhtichou  ben  Djordis, 
the  son  of  George  and  his  successor  in  the  work  of  trans- 
lating from  the  Greek,  to  consult  with  the  regularly 
appointed  physicians  of  the  Court  in  regard  to  the  nature 
and  proper  treatment  of  his  malady.  The  consultation 
took  place  at  the  appointed  time,  and  one  of  the  Caliph's 
physicians,  thinking  that  he  might  catch  Bakhtichou  in  a 
trap,  submitted  to  him  a  specimen  of  urine  which  purported 
to  come  from  the  Caliph,  but  which  in  reality  had  been 
obtained  from  a  beast  of  burden.  Alraschid,  who  knew  of 
the  deception,  asked: — 

''What  remedy  would  you  administer  to  the  person  from 
whom  this  urine  came  ? ' ' 

Bakhtichou,  who  had  been  clever  enough  to  recognize  the 
true  character  of  the  specimen,  replied  promptly :  ' '  Some 
oats,  your  Majesty." 

The  Caliph  laughed  heartily  over  the  episode,  loaded 


THE  ARAB  RENAISSANCE  207 

George's  son  with  presents,  and  appointed  him  the  chief 
of  all  his  physicians, — the  first  instance  among  the  Ara- 
bians, it  is  said,  of  the  appointment  of  an  Archiater. 

Bakhtichou  ben  Djordis  was  the  author  of  a  collection 
of  short  medical  treatises,  and  he  also  wrote,  for  the  special 
use  of  his  son  Gabriel,  a  medical  **  remembrancer. "  He 
was  as  highly  esteemed  by  the  Arabs  as  his  father  had  been 
before  him.    The  date  of  his  death  is  not  known. 

Gabriel,  the  son  of  Bakhtichou  and  a  grandson  of  the 
famous  George  Bakhtichou,  was  the  most  distinguished 
member  of  this  remarkable  family  of  physicians.  In  the 
year  792  A.  D.,  five  years  after  the  consultation  mentioned 
above  had  taken  place,  Gabriel  was  sent  by  his  father  to 
give  medical  advice  to  Jafar,  the  son  of  the  Grand  Vizier. 
The  treatment  which  he  recommended  proved  to  be  entirely 
successful,  and,  pleased  with  the  result,  Jafar  soon  after- 
ward had  an  opportunity  to  speak  to  Haroun  Alraschid 
of  Gabriel  as  the  physician  best  fitted  to  effect  a  cure  in 
the  case  of  his  own  favorite  wife,  who,  in  a  fit  of  yawning, 
had  dislocated  her  shoulder.  The  Arabian  physician  had 
tried  friction,  different  sorts  of  ointments,  and  manipu- 
lations of  every  imaginable  kind,  but  all  in  vain.  The 
dislocation  still  persisted.  When  Gabriel  arrived  on  the 
scene  he  told  the  Caliph  that  he  could  bring  the  shoulder 
back  into  place  provided  no  offense  would  be  taken  at  the 
means  which  he  was  about  to  employ.  Alraschid  gave  the 
desired  promise  and  Gabriel  made  a  movement  as  if  he 
were  about  to  lift  up  the  bed-clothes.  Instantly  the  patient, 
through  a  natural  sense  of  modesty,  stretched  out  her 
dislocated  arm  to  keep  the  bed-covering  in  place.  *  *  There ! 
she  is  cured ! ' '  exclaimed  Gabriel,  and  such  indeed  was  the 
truth.  The  sudden  movement  of  the  limb  had  reduced  the 
dislocation. — It  only  remains  for  me  to  add  that  the  sum 
of  500,000  drachmae^  was  paid  to  Gabriel  by  Haroun 
Alraschid  for  his  successful  treatment. 

Some  surprise  having  been  expressed  by  the  Caliph  *s 

3  The  drachma  was  a  silver  coin  worth  about  9%  pence  English  money.  The 
fee  paid  to  Gabriel  for  his  surgical  services  amounted,  therefore,  to  a  little  less 
than  £2000  or  $10,000. 


208  GROWTH  OF  MEDICINE 

relatives  that  he  should  display  such  extravagant  gener- 
osity toward  a  Christian,  he  replied:  ''The  fate  of  the 
empire  is  bound  up  in  my  fate,  and  my  life  is  in  the  hands 
of  Gabriel." 

Gabriel  Bakhtichou  died  in  the  early  part  of  the  ninth 
century,  not  long  after  the  Caliph  El  Mamoun  had  started 
on  his  expedition  against  the  Greeks  (828  A.  D.).  He  was 
the  author  of  several  medical  treatises,  and,  like  his  famous 
grandfather,  George  Bakhtichou,  he  did  everything  in  his 
power  to  promote  the  work  of  translating  from  the  Greek 
into  the  Arabic.  Gabriel's  brother,  also  named  George, 
and  his  son  Bakhtichou  ben  Djabriel  were  both  of  them 
physicians  of  considerable  distinction.  The  latter  accom- 
panied El  Mamoun  on  his  expedition  against  the  Greeks. 
It  is  a  fact  worth  noting  here,  that  throughout  this  war 
the  Caliph  never  for  a  moment  lost  sight  of  the  great 
national  scheme  of  education  which  his  predecessor 
Almansur  had  inaugurated  and  which  was  still  engaging 
the  time  and  best  efforts  of  many  scholars  and  copyists  in 
Bagdad.  Whenever  he  captured  a  city  he  insisted  upon 
the  delivery  to  him  of  whatever  copies  of  scientific  treatises 
its  citizens  might  possess.  But  even  these  extraordinary 
methods  of  securing  the  books  which  they  needed  did  not 
satisfy  the  Arabs,  their  eagerness  to  accumulate  as  many 
text  books  as  possible  being  insatiable.  Accordingly,  from 
time  to  time,  one  of  the  translators — some  member  of  the 
Bakhtichou  family,  for  example — ^would  be  sent  to  the 
different  cities  of  Syria  and  Persia  to  search  out  and  get 
possession  of  as  many  Greek  manuscripts  as  possible. 
Thus,  Honein  is  reported  to  have  said :  ' '  I  have  not  been 
able  to  procure  a  complete  copy  of  Galen 's  *  Demonstration. ' 
Gabriel  endeavored  to  find  a  copy,  but  did  not  succeed ;  and 
I  myself  hunted  through  Irak,  Syria,  Palestine  and  Egypt, 
but  was  at  last  only  partially  successful.  I  found  one-half 
of  the  text  in  Damascus." 

The  work  of  translation  was  kept  up  with  unremitting 
zeal  until  the  middle  of  the  ninth  century  (reigns  of  El 
Ouatocq  and  of  Moutaouakkel). 

Among  the  physicians  who  received  their  training  at  the 


TEE  ARAB  RENAISSANCE  209 

Djondisabour  medical  school  the  Bakhtichous  were  not  the 
only  ones  who  attained  considerable  distinction.  John 
Mesne  the  Elder,*  for  example,  who  was  a  Nestorian 
Christian  and  the  son  of  an  apothecary,  became  more 
famous  than  any  member  of  that  family.  He  not  only  did 
his  full  share  of  the  translating,  but  he  was  also  a  prolific 
author  and  a  very  faithful  and  efficient  teacher,  Galen's 
writings  furnishing  the  basis  of  his  lectures.  He  lived  to 
be  about  eighty  years  of  age,  his  death  occurring  in  857 
A.  D.  Most  of  his  writings  have  been  lost.  Of  the  twenty 
or  more  which  have  come  down  to  our  time  those  bearing 
the  following  titles  deserve  to  receive  special  mention: — 

Book  of  Fevers. 

On  the  Different  kinds  of  Food  and  Drink. 

On  Venesection  and  Scarifications. 

On  Tubercular  Leprosy. 

On  Abnormal  Prominence  of  the  Abdomen. 

On  Purgative  Remedies. 

On  Baths. 

On  the  Regulation  of  Diet. 

On  Poisons  and  Poisoning. 

On  Vertigo. 

On  the  Treatment  of  Sterility. 

On  Dentifrices  and  Gargles. 

Sabour  ben  Sahl,  whose  death  occurred  in  869  A.  D.,  was 
also  connected  with  the  hospital  at  Djondisabour.  He  was 
distinguished  on  account  of  his  special  knowledge  of  the 
properties  of  simple  drugs  and  their  combinations.  He 
was  also  the  author  of  the  exhaustive  formulary  known  as 
Acrahadin  Kehir — probably  the  first  one  of  its  kind,  says 
Le  Clerc,  of  which  history  makes  any  mention.  This 
formulary  or  dispensatory — of  which  a  large  and  a  small 
edition  existed — was  in  general  use  in  all  the  hospitals, 
physicians'  offices,  etc.,  of  that  time. 

Still  another  most  distinguished  physician  and  author  of 
medical  treatises  received  his  training  at  the  Djondisabour 

4  To  distinguish  him  from  Mesufi  the  Younger,  who  lived  at  Cairo,  Egypt, 
ahout  one  hundred  years  later,  and  who  attained  considerable  celebrity  on 
account  of  the  treatises  which  he  wrote  on  materia  mediea. 


210  GROWTH  OF  MEDICINE 

school — viz.,  John,  son  of  Serapion  (or  Serapion  the  Elder, 
as  he  is  commonly  called).  He  lived  about  the  middle  of 
the  ninth  century  of  the  Christian  era  and  wrote  entirely 
in  the  Syrian  language,  but  at  a  later  date  his  works  were 
all  translated  into  Arabic.  The  smaller  of  his  two  most 
important  treatises,  and  at  the  same  time  the  one  which 
appears  to  have  attracted  the  most  attention,  was  called 
the  Kounnach.  About  the  middle  of  the  twelfth  century 
A.  D.  it  was  translated  into  Latin  by  Gerard  of  Cremona, 
and  named  by  him  Breviarium;  a  still  later  translation 
received  the  name  of  Practica.  The  first  part  of  this 
smaller  treatise  (the  Breviarium  or  the  Practica)  is 
divided  into  six  books,  the  titles  of  which  are  as  follows : — 

1.  On  Nodosities,  Ophiasis,  and  Alopecia. 

2.  On  the  Falling  Out  of  the  Eyelashes. 

3.  On  the  Mild  Form  of  Tinea,  the  form  which  resembles  Favus. 

4.  Scaly  Affections  of  the  Head  and  of  Other  Parts  of  the  Skin. 

5.  Lice  of  the  Head  and  of  the  Body. 

6.  Headache  caused  by  Exposure  to  the  Sun;  and  other  forms 
of  Cephalalgia. 

Salmouih  ben  Bayan,  a  Christian,  was  the  last  one  of 
the  pupils  of  the  Djondisabour  school  who  attained  con- 
siderable celebrity  as  a  physician.  When  the  Caliph 
Motassem  came  to  the  throne  in  833  A.  D.,  he  appointed 
Salmouih  his  personal  physician  and  soon  became  very 
much  attached  to  him;  leaning  upon  him  more  and  more 
for  advice  in  all  sorts  of  troubles.  Salmouih  was  the  author 
of  several  medical  treatises,  but  they  have  all  been  lost, 
not  even  their  titles  are  now  known  to  us.  When  dying 
(early  in  840  A.  D.),  he  sent  word  to  the  Caliph  not  to  put 
his  entire  trust  in  the  medical  judgment  of  Mesne  if  he 
should  find  it  necessary  to  call  upon  the  latter  for  advice 
in  the  event  of  a  serious  attack  of  illness.  This  celebrated 
physician  was  universally  admitted  to  be  most  learned  in 
everything  relating  to  medicine,  but  there  were  many  of 
his  professional  brethren — and  Salmouih  was  among  the 
number — who  did  not  esteem  him  so  highly  as  a  practitioner. 
''The  most  important  thing  in  medicine,"  said  the  latter, 


THE  ARAB  RENAISSANCE  211 

*'is  to  appreciate  correctly  the  intensity  of  the  disease,  and 
that  is  something  which  Mesne,  with  all  his  learning,  is  not 
able  to  do."  However,  despite  the  death-bed  warning 
given  by  Salmouih  to  Motassem,  this  ruler  died  less  than 
two  years  later  from  the  effects  of  the  treatment  which 
Mesne  the  Elder,  who  had  been  called  in  to  prescribe  for 
his  Highness,  had  ordered. 

In  addition  to  the  pupils  already  mentioned  there  are  a 
few  others  who,  according  to  the  testimony  of  Le  Clerc, 
reflected  some  credit  upon  the  institution  in  which  they 
acquired  their  medical  training.  But  enough  has  already 
been  said,  I  believe,  to  establish  the  fact  that,  in  this  remote 
Persian  province  of  Khorassan  (to  the  west  of  the  country 
known  to-day  as  Afghanistan),  there  existed  during  the 
eighth  and  ninth  centuries  of  the  present  era  a  most 
efficient  medical  school,  which  was  entirely  managed  by 
Nestorian  Christians,  and  which  sent  out  into  the  world 
trained  physicians  of  the  very  highest  type. 


CHAPTER  XIX 

FURTHER  ADVANCE  OF  THE  ARAB  RENAISSANCE 
DURING  THE  NINTH  AND  SUCCEEDING  CEN- 
TURIES OF  THE  CHRISTIAN  ERA 

During  the  latter  part  of  the  eighth  century  the  Arab 
Renaissance,  so  far  at  least  as  the  science  of  medicine 
was  concerned,  was  controlled  and  kept  in  vigorous  life 
almost  entirely  by  physicians  who  were  connected  with  the 
school  at  Djondisabour — one  might  almost  say,  by  physi- 
cians who  were  members  of  the  Bakhtichou  family.  To 
this  family,  therefore,  belongs  the  chief  credit  for  the 
admirable  results  attained  during  this,  the  first  stage  of 
the  Renaissance.  But  during  the  ninth  century  A.  D.  men 
who  had  not  received  their  professional  training  at  this 
famous  school  came  to  the  fore  and  gave  a  fresh  and  a  more 
vigorous  impulse  to  the  work  than  their  predecessors  had 
given.  Under  the  Bakhtichous  the  translating  had  been 
well  started,  and  in  addition  a  few  original  medical  treatises 
had  been  written  in  the  Arabic  language.  During  the 
period  which  followed,  however,  the  translating  and  copying 
became  more  active  than  before,  and,  in  addition,  several 
really  valuable  treatises  were  produced  by  men  who  wrote 
in  Arabic,  and  who  were — if  not  racially  Arabs — at  least 
the  adopted  sons  of  that  nation.  Of  these  men  none  stands 
out  more  prominently  than  Honein,  who,  according  to 
Le  Clerc,  **  accomplished  a  marvellous  amount  of  work  of 
the  most  varied  character  and  of  a  very  high  degree  of 
excellence,  and  that  too  despite  many  obstacles.  While 
he  was  not  the  originator  of  the  Renaissance  in  the  East, 
he  took  the  most  active  part  in  keeping  it  up." 

Honein,  who  may  rightly  be  considered  as  having  at 
least  inaugurated  the  second  stage  of  the  Arab  Renais- 


THE  ARAB  RENAISSANCE  213 

sance,  was  born  in  809  A.  D.  at  Hira,  where  his  father 
Isaac,  a  Christian  Arab,  conducted  a  pharmacy.  The 
inhabitants  of  this  town  were  known  to  be  somewhat 
lacking  in  cultivation,  and  it  was  therefore  not  surprising 
that,  when  Honein  went  to  Bagdad  and  presented  himself 
to  John,  the  son  of  Mesue,  as  one  who  wished  to  become  his 
pupil,  his  request  was  promptly  declined  on  the  general 
ground  that  the  people  of  Hira  had  not  received  sufficient 
education  to  warrant  any  one  of  their  number  in  under- 
taking the  study  of  medicine.  This  decision  was  of  course 
a  great  disappointment  to  Honein,  but  it  disturbed  him 
only  for  a  short  time.  Soon  afterward  he  went  to  Greece 
where  he  worked  hard  to  perfect  himself  in  the  knowledge 
of  the  Greek  language.  Then,  after  a  residence  of  two 
years  in  that  country,  he  returned  to  Bagdad,  taking  with 
him  a  considerable  supply  of  Greek  books.  His  next  step 
was  directed  toward  gaining  a  better  knowledge  of  Arabic, 
iand  with  this  object  in  view  he  spent  some  time  in  Bassora, 
a  town  which  was  situated  not  far  to  the  south  of  Bagdad, 
and  which  possessed  good  educational  facilities.  While 
residing  there  he  devoted  a  certain  portion  of  his  time  to 
the  translation  of  Galen 's  treatise  on  anatomy ;  and  he  was 
accordingly  prepared,  upon  his  return  to  Bagdad,  to  sub- 
mit to  John,  the  son  of  Mesne,  and  to  Gabriel,  the  son  of 
Bakhtichou  (who  by  that  time  was  well  advanced  in  years), 
a  specimen  of  the  work  upon  which  he  had  been  engaged. 
Both  of  these  men  were  greatly  pleased  with  the  excellence 
of  the  translation,  and  encouraged  Honein  to  go  on  with 
the  work.  El  Mamoun  (the  second  son  of  Haroun  Alras- 
chid),  who  was  the  then  reigning  Caliph,  engaged  his 
services  both  as  a  translator  of  Greek  writings  (into  Syriac 
as  well  as  Arabic)  and  as  a  reviser  of  the  translations 
which  had  been  made  by  others,  and  he  paid  him  most 
generously  for  these  services.  According  to  Le  Clerc,  the 
amount  of  literary  work  done  by  Honein  was  simply 
prodigious.  He  translated  large  portions  of  the  treatises 
of  Galen,  Oribasius  and  Paulus  Aegineta,  as  well  as  several 
of  the  works  of  Aristotle  and  of  Plato,  of  the  mathema- 
ticians and  astronomers,  and  also  of  the  philosophers ;  and 


214  GROWTH  OF  MEDICINE 

in  addition  he  wrote  a  large  number  of  original  treatises — 
such,  for  example,  as  a  complete  set  of  commentaries  on 
the  writings  of  Hippocrates,  a  practical  work  on  the 
diseases  of  the  eyes,  etc. 

The  following  account  of  Honein's  experience  at  the 
Court  of  the  Caliph  Moutaouakkel  (middle  of  the  ninth 
century  A.  D.)  furnishes  some  insight  into  his  character: — 

The  Caliph,  who  had  heard  of  the  great  learning,  ability,  and 
industry  of  Honein,  but  who  had  at  the  same  time  feared  that  he 
might  be  in  secret  communication  with  the  Greeks,  decided  to 
subject  him  to  a  test  that  would  reveal  how  far  he  was  venal. 
Accordingly  he  sent  for  him,  clothed  him  in  robes  of  honor,  gave 
him  50,000  drachmae,  and  then  said: 

*'I  wish  that  thou  wouldst  prepare  for  me  a  secret  combination 
of  drugs  which  will  enable  me  to  get  rid  of  one  of  my  enemies. ' ' 

Honein  replied:  ''I  have  no  knowledge  of  any  but  salutary 
remedies,  and  it  never  occurred  to  me  that  the  Prince  of  Believers 
might  ask  me  to  furnish  those  of  a  different  kind.  However,  if  it 
be  the  wish  of  your  Majesty,  I  will  see  what  I  can  do ;  but  I  shall 
require  plenty  of  time." 

After  waiting  in  vain  for  the  desired  preparation  and  finding 
that  even  threats  failed  to  accomplish  anything*,  the  Caliph  put 
Honein  in  prison.  Then,  at  the  end  of  a  year,  which  interval  the 
latter  had  employed  diligently  in  the  work  of  translating, 
Moutaouakkel  gave  orders  for  the  prisoner  to  be  brought  into  his 
presence.  Before  this  was  done,  however,  a  heap  of  objects  of 
value  was  placed  on  one  side  of  the  room  and  instruments  of 
torture  on  the  other.  When  Honein  was  brought  in,  the  Caliph 
said  to  him :  ' '  Time  is  passing,  and  my  wishes  have  not  yet  been 
gratified.  If  thou  art  now  ready  to  obey  my  behest,  these  treasures 
and  many  others  in  addition  shall  be  thine.  But,  if  thou  continuest 
to  refuse,  I  will  subject  thee  to  tortures  and  will  finally  put  thee 
to  death." 

"I  have  already  told  the  Prince  of  Believers,"  replied  Honein, 
"that  my  knowledge  is  limited  to  the  preparation  of  salutary 
remedies. ' ' 

Whereupon  the  Caliph  said:  "Have  no  fear!  I  simply  wished 
to  test  thee!  But  tell  me,  what  are  the  reasons  upon  which  thy 
refusal  is  based?" 

' '  There  are  two  reasons, ' '  replied  Honein :  *  *  my  religion  and  my 
profession.     The  first  teaches  us  to  do  good  to  our  enemies;  and 


THE  ARAB  RENAISSANCE  215 

the  second,  not  to  do  any  harm  to  the  human  race.    Every  physician 
has  registered  an  oath  that  he  will  never  administer  a  poison." 

"Those  are  two  excellent  laws,"  remarked  the  Caliph;  and  he 
proceeded  to  load  Honein  with  presents. 

Among  those  who  were  associated  with  Honein  in  his 
work  of  translating  Greek  medical  books  into  Arabic  there 
are  three  whose  names  also  deserve  to  be  remembered. 
They  are :  his  son  Isaac ;  his  nephew  Hobeich ;  and  a  Chris- 
tian Greek  named  Costa  ben  Luca,  whose  residence  was  at 
Baalbek.  To  men  of  the  present  time  all  these  names  of 
oriental  physicians  are,  as  a  rule,  mere  meaningless  words, 
conveying  no  idea  of  an  important  relationship  to  the 
evolution  of  medicine.  During  the  ninth  and  tenth  cen- 
turies of  the  present  era,  however,  and  indeed  for  many 
years  subsequent  to  that  time,  they  were  accorded  by  the 
physicians  of  that  period  almost  as  much  honor  for  the 
part  which  they  took  in  furthering  the  revival  of  medicine 
among  the  Arabs  as  was  given  to  Honein  himself.  It  seems 
therefore  appropriate  that  at  least  a  brief  account  of  the 
lives  of  these  men  and  of  the  work  which  they  did  should 
be  given  here. . 

Isaac  received  his  education  from  his  father  Honein,  and 
soon  after  reaching  manhood  he  was  set  to  work  trans- 
lating from  the  Greek  into  both  Syrian  and  Arabic — two 
sister  languages.  He  was  a  man  of  great  intelligence,  and 
was  thought  by  many  to  be  the  equal  of  his  father  in  the 
knowledge  of  Greek,  Syriac  and  Arabic.  He  also  had,  like 
his  father,  the  good  fortune  to  find  favor  with  the  rulers 
of  that  period.  He  died  in  912  A.  D.  as  the  result  of  a 
stroke  of  cerebral  apoplexy.  In  addition  to  his  trans- 
lations he  wrote  original  treatises  on  the  following  topics : — 

Simple  Medicaments. 

Origins  of  Medicine. 

Correctives  of  Purgative  Remedies. 

Treatment  by  Cutting  Instruments. 

The  means  of  Preserving  the  Health  and  the  Memory. 

Hobeich  was  the  son  of  Honein 's  sister.  The  date  of  his 
birth  is  not  known.    He  received  his  training  in  the  Ian- 


216  GROWTH  OF  MEDICINE 

guages  from  Ms  uncle,  and  in  the  course  of  time  became 
associated  with  the  latter  in  the  work  of  translating. 
Eventually  he  reached  his  uncle 's  high  standard  of  scholar- 
ship, and  the  text  of  his  translations  was  from  that  time 
forth  accepted  without  any  revision.  The  Caliph  Mou- 
taouakkel  appointed  him  Court  Physician,  and  the  imme- 
diate successors  of  this  Caliph  retained  him  in  the  same 
position.  His  death  occurred  during  the  second  half  of 
the  ninth  century  of  the  Christian  era. 

Hobe'ich  translated  the  ''Oath  of  Hippocrates"  and  a 
large  number  of  the  more  important  of  Galen's  treatises. 
In  addition,  he  left  to  posterity  several  original  writings. 
Quotations  from  these  are  to  be  found  in  the  works  of 
Rhazes,  of  Ebn  el  Beithar,  and  of  Serapion  the  Younger, 
and  they  reveal  two  important  facts:  first,  that  Hobeich 
was  an  excellent  practicing  physician ;  and,  second,  that  the 
Arabs  had  already  at  this  comparatively  early  date  begun 
to  gather  their  medical  information  from  other  sources 
than  the  Greek  treatises.  The  following  drugs,  for 
example,  are  described  by  Hobeich  in  the  quotations  just 
mentioned,  and  yet  they  do  not  appear  to  have  been  known 
to  the  Greek  medical  writers :  Turbith,  Convolvulus  of  the 
Nile,  Nux  Vomica,  Colocynth,  Croton  Tiglium,  Aloes  and 
Myrobolans. 

Costa,  the  son  of  Luca,  was  a  Christian  Greek  from 
Baalbek,  in  Syria.  The  dates  of  his  birth  and  death  are 
not  known,  but  it  is  believed  that  he  lived  during  the  first 
half  of  the  tenth  century  of  the  present  era.  He  was  an 
excellent  Greek  and  Arabic  scholar  and  was  also  familiar 
with  the  Syriac  language.  His  translations  were  esteemed 
equal  to  those  of  Honein.  After  spending  some  time  in 
Greece  he  settled  in  Irak,  a  province  of  Persia,  and  devoted 
himself  to  the  translation  of  the  books  which  he  had 
brought  with  him  from  Greece.  At  a  later  period  of  his 
life  he  removed  to  Armenia,  a  country  which  lies  to  the 
north  of  Irak,  between  it  and  the  Black  Sea,  and  it  was 
during  his  residence  there  that  he  wrote  a  number  of 
treatises.  It  was  in  Armenia,  also,  so  far  as  may  be  judged 
from  the  accounts  which  we  possess,  that  his  death  took 


THE  ARAB  RENAISSANCE  217 

place.  As  an  evidence  of  the  fact  that  he  was  highly 
esteemed  by  his  contemporaries,  his  biographer  states  that 
a  cupola  was  built  over  his  tomb. 

Among  the  medical  works  which  he  translated  from  the 
Greek  the  following  are  the  only  ones  of  special  impor- 
tance: The  Aphorisms  of  Hippocrates,  and  Galen's  com- 
mentaries upon  them. 

The  ninth  century,  the  period  during  which  the  major 
portion  of  the  work  described  in  the  preceding  part  of  this 
chapter  was  accomplished,  is  considered  by  Lucien  Le  Clerc 
the  most  remarkable  in  the  world's  history.  He  speaks  of 
it  in  the  following  terms : — 

Its  greatness  is  emphasized  by  the  fact  that,  except  in  this  one 

corner  of  the  globe,  everything  was  in  a  state  of  decadence 

Great  as  is  the  credit  due  the  Abbaside  Djmasty  and  its  ministers, 
still  greater  is  our  admiration  for  the  Arab  nation  on  account  of 
the  eagerness  with  which  it  met  the  wishes  of  its  rulers  and  also 
because  it  pursued  resolutely,  and  despite  all  the  obstacles 
(political  and  religious)  which  were  placed  in  its  way,  the  course 

laid  down  for  it  to  follow The  Arabs  also  knew  how  to 

choose  men  who  were  really  eminent  and  to  rescue  them  from  lives 
which  otherwise  would  probably  have  been  sterile;  they  claimed 
the  inheritance  of  Greek  science;  and  they  revealed  to  the  world 
that  they  were  worthy  of  this  inheritance. 

Some  idea  of  the  completeness  of  the  list  of  Greek 
medical  works  which  the  Arabs  translated  may  be  gained 
from  the  fact  that  Galen's  writings  are  more  complete  in 
the  Arabic  than  they  are  in  the  Greek,  the  language  in 
which  they  were  originally  composed. 

With  Costa  the  second  stage  in  the  Arab  Renaissance 
came  to  an  end.  All  the  work  accomplished  at  Bagdad 
up  to  this  period  in  our  history  received  its  inspiration 
from  the  different  Caliphs  belonging  to  the  Abbaside 
Dynasty.  But  now  the  political  conditions  in  the  East 
underwent  a  change,  and  other  Arabian  dynasties,  each  in 
its  turn,  gained  control  of  the  power  previously  wielded 
by  Almansur,  Haroun  Alraschid  and  their  successors. 
Fortunately,  all  of  these  new  rulers  seem  to  have  been 
favorably  inclined  toward  the  revival  of  literature,  and 


218  GROWTH  OF  MEDICINE 

consequently  the  Arabs  continued  to  take  an  active  part 
in  the  advance  of  medical  knowledge  during  the  tenth  and 
eleventh  centuries.  Bagdad,  however,  ceased  to  be  the 
centre  of  all  this  intellectual  activity,  and  eventually 
Cordova  in  Spain  almost  rivaled  the  capital  of  ancient 
Greece  in  the  eagerness  with  which  she  sought  to  increase 
her  stores  of  books,  and  in  her  readiness  to  honor  scholars. 
By  this  time  the  Arabs  controlled,  not  only  Persia  and 
Arabia,  but  also  Egypt,  Palestine,  Syria,  Marseilles,  the 
coast  of  Asia  Minor,  Greece,  Sicily,  the  northern  part  of 
Africa  and  Spain.  Owing  to  the  limited  space  at  my 
command  I  shall  be  obliged  to  confine  my  account  to  the 
more  salient  features  of  the  progress  made  during  this 
later  or  third  stage  of  the  Arab  Eenaissance. 

Already  as  early  as  toward  the  end  of  the  ninth  century 
the  number  of  physicians  in  the  East  had  increased  so 
greatly,  and  the  territory  where  well-educated  medical  men 
were  to  be  found  had  broadened  to  such  an  extent,  that  I 
shall  now  be  obliged,  in  order  to  maintain  some  approach 
to  chronological  order  in  my  account  of  the  evolution  of 
medical  science,  to  treat  the  subject  according  to  countries. 
If  the  men  who  stand  out  foremost  in  this  third  stage  of 
the  scientific  renaissance  are  not  in  every  instance  Arabs 
or  Persians  or  Syrians,  I  may  at  least  claim  that  they  are 
the  product,  directly  or  indirectly,  of  the  great  Arab  move- 
ment. The  countries  in  w^hich  their  best  work  was  done 
are  the  following:  Persia  (apart  from  Bagdad  and  its 
immediate  neighborhood),  Egypt,  Magreb  (the  modern 
Algiers  and  Tunis ) ,  Fez  and  Spain.  But,  before  I  consider 
the  progress  of  medicine  in  these  different  parts  of  the 
Orient,  I  should  say  at  least  a  few  words  about  the  events 
which  characterized  the  cessation  of  literary  work  at 
Bagdad.  As  might  be  expected,  that  city,  after  the  Greek 
medical  and  scientific  treatises  had  all  been  translated 
into  Arabic,  gradually  lost  its  pre-eminence  as  a  centre  of 
learning,  and  new  centres  developed  in  other  cities  through- 
out the  vast  Musulman  Empire.  It  must  not  be  inferred, 
however,  that  this  change  was  wholly  or  even  largely  due 
to  the  cessation  of  literary  work.    Other  factors  contributed 


THE  ARAB  RENAISSANCE  219 

to  this  result,  viz. :  the  decadence  of  the  caliphate  and  the 
fact  that  the  caliphs  themselves  appeared  to  lose  their 
interest  in  promoting  the  sciences  actively.  It  was  not 
until  during  the  tenth  century  that  any  further  interest 
in  the  advancement  of  medical  science  was  taken  by  those 
in  authority  at  Bagdad.  Then  the  Emir  Adhad  Eddoula 
built  a  splendid  hospital,  and  organized  it  on  the  basis  of 
several  separate  services — one  for  fever  cases,  another  for 
accidental  injuries,  a  third  for  ophthalmic  cases,  and  so  on. 
Twenty-four  physicians,  who  had  been  selected  because  of 
their  special  aptitude  for  some  particular  class  of  medical 
work,  were  appointed  to  take  charge  of  the  diiferent  ser- 
vices ;  and  it  is  interesting  to  note  that  nearly  all  of  these 
men  bear  Arab  names.  Nevertheless,  for  a  still  further 
period  of  many  years,  says  Le  Clerc,  there  continued  to  be 
as  many  Christian  as  Mohammedan  physicians  in  Bagdad. 

In  the  tenth  century  other  hospitals  were  established  in 
Bagdad.  Thus,  in  914  A.  D.,  the  Vizir  Ali  ben  Issa  founded 
one  which  he  endowed  in  the  most  liberal  manner.  This 
Vizir  must  have  been  a  most  humane  person,  for,  when 
the  physician-in-charge  wrote  to  him  for  further  instruc- 
tions regarding  the  course  which  he  should  pursue  mth 
respect  to  people  of  different  religions,  the  Vizir  replied: 
*'Use  the  fund  for  the  benefit  of  all  classes  alike,  and  be 
sure  to  remember  the  animals." 

Persia. — Ehazes,  whose  full  name  is  Abou  Beer  Moham- 
med ben  Zakarya,  is  generally  admitted  to  have  been  the 
most  illustrious  of  Persia's  physicians,  and  probably  the 
most  distinguished  representative  of  Arab  medical  learn- 
ing. He  was  born  at  Raj,  in  the  Province  of  Khorassan, 
about  850  A.  D.  After  he  had  received  his  professional 
training  at  Bagdad,  he  settled  at  Raj  and  was  soon  after- 
ward appointed  director  of  the  local  hospital.  At  a  later 
date  he  was  placed  in  charge  of  the  hospital  at  Bagdad, 
but  before  many  months  had  elapsed  he  returned  to  Raj, 
his  native  town,  and  here  he  spent  most  of  the  remaining 
years  of  his  long  life.  The  date  of  his  death  is  stated  by 
Haeser  as  either  923  or  932  A.  D.,  but  Le  Clerc  mentions 
only  the  latter  date. 


220  GROWTH  OF  MEDICINE 

Ehazes  was  a  very  hard  worker  and  was  Mghly  esteemed 
by  his  fellow  countrymen,  who  called  him  the  Arabian 
Galen.  The  total  number  of  writings  which  he  left  behind 
him  at  the  time  of  his  death  was  237,  most  of  them  dealing 
with  medical  subjects.  A  few  of  them,  however,  were  de- 
voted to  the  discussion  of  chemical,  anatomical  and  philo- 
sophical questions.  To-day  we  possess  only  36  of  the 
treatises  written  by  Rhazes,  and  of  this  number  only  six 
have  been  printed  in  Latin.  His  greatest  work,  as  all 
critics  admit,  is  that  which  is  commonly  known  as  the 
''Continens"  (or  **E1  Haouy")-  In  this  work,  which  is 
divided  into  twenty-two  books,  Rhazes  gives  in  a  con- 
densed form  the  views  entertained  by  all  his  predecessors 
regarding  the  more  important  questions  in  medical  science, 
and  then  adds  thereto  the  conclusions  which  his  own  expe- 
rience has  led  him  to  form. 

He  also  wrote  a  second  treatise  (in  ten  books)  which 
was  esteemed  by  the  physicians  of  that  and  later  periods 
almost  as  highly  as  the  Continens.  It  was  called  the  '*Man- 
soury,"  and  its  contents  are  distributed  as  follows:  I., 
Anatomy;  II.,  the  Different  Temperaments;  III.,  Alimen- 
tary Substances  and  Drugs;  IV.,  Hygiene;  V.,  Cosmetics; 
VI.,  the  Regimen  to  be  adopted  in  Traveling;  VII.,  Sur- 
gery; VIIL,  Poisons;  IX.,  Maladies  in  General;  X.,  Fevers. 

A  third  treatise  of  considerable  importance  is  that  which 
is  devoted  by  Rhazes  to  the  description  and  treatment  of 
small-pox  and  measles.  So  far  as  is  known  at  the  present 
time  this  is  the  first  treatise  that  has  been  written  on  these 
diseases,  and  its  celebrity  rests,  not  only  upon  this  cir- 
cumstance, but  also  upon  the  facts  that  its  author  is  evi- 
dently familiar  with  the  different  types  of  small-pox  and 
with  the  characteristic  features  which  distinguish  this  dis- 
ease from  measles.  Freind,  in  commenting  upon  this 
treatise,  says  that  Rhazes  assigned  for  small-pox  a  cause 
"entirely  new  in  physick,  a  sort  of  an  innate  contagion. 
This  is  a  ferment  in  the  blood,  like  that  in  must,  which 
purifies  itself  sooner  or  later  by  throwing  off  the  peccant 
matter  at  the  glands  of  the  skin;  an  hypothesis  since  ap- 
plied, though  upon  very  slight  grounds,  to  feavers  in  gen- 


THE  ARAB  RENAISSANCE  221 

eral  by  many  moderns."  From  this  account  it  is  fair  to 
conclude  that  Ehazes,  in  the  tenth  century  of  the  Christian 
era,  as  clearly  suspected  the  germ  origin  of  certain  febrile 
diseases  as  Liebermeister  did  toward  the  end  of  the  nine- 
teenth, or  as  Fracastoro  did  in  the  sixteenth.  And  one  can- 
not help  exclaiming:  How  many  centuries  had  to  elapse, 
and  what  an  immense  amount  of  other  facts  had  still  to 
be  discovered — facts  in  anatomy,  in  physiology,  in  chem- 
istry, in  optics,  etc. — before  it  became  possible  to  convert 
this  suspicion,  this  simple  product  of  the  reasoning  faculty, 
into  an  actual  demonstration  of  the  truth  in  pathology! 

Among  the  Arabian  physicians  of  the  eleventh  century 
Avicenna  is  certainly  one  who  should  be  placed  in  the  first 
rank.  He  was  born  in  980  A.  D.  at  Afschena,  a  village  in 
the  Province  of  Khorassan,  Persia,  and  spent  his  youth 
in  Bokhara,  where  his  father  held  some  high  office  under 
the  Government.  His  great  intellectual  capacity  was  re- 
vealed at  an  early  age.  It  is  said,  for  example,  that  already 
before  he  was  ten  years  old  he  had  committed  the  entire 
Koran  to  memory;  and  it  is  added,  further,  that  when  he 
was  only  seventeen  years  old  he  had  already  acquired  such 
knowledge  of  medicine  that  he  was  invited  to  take  part  in 
a  consultation  regarding  some  malady  with  which  the  Emir 
Nuch  ben  Mansur  was  affected.  The  advice  which  he  gave 
on  this  occasion  was  followed,  and  in  the  sequel  it  proved 
so  good  that  he  was  granted,  as  a  reward,  unrestricted 
access  to  the  royal  library, — a  privilege  which  he  utilized 
to  the  very  best  advantage.  When  his  father  died  Avicenna 
came  into  possession  of  a  large  fortune,  which  enabled  him 
to  indulge  in  a  great  deal  of  traveling.  In  this  way  he 
visited  one  Persian  Court  after  another  throughout  a 
period  of  several  years.  Finally,  during  a  residence  at 
Hamadan,  the  Prince  Schems  ed-Daula,  whom  Avicenna 
had  successfully  treated  for  some  malady,  made  him  his 
Vizir.  While  he  held  this  office  he  managed,  without 
neglecting  his  official  duties,  to  continue  his  scientific 
studies ;  but  he  was  not  able  entirely  to  keep  out  of  political 
intrigues,  and  as  a  consequence  his  life  was  for  a  short 
time  in  some  danger.    He  was  confined  for  several  months 


222  GROWTH  OF  MEDICINE 

in  a  fortress,  from  whicli,  however,  he  managed  eventually 
to  make  his  escape  to  the  Court  of  Ibn  Kakujah,  in  Ispahan. 
He  resided  in  that  city  during  the  following  fourteen  years, 
and  it  was  there  that  he  wrote  his  two  principal  works — 
the  famous  medical  treatise  known  as  the  *' Canon,"  and 
the  equally  celebrated  cyclopaedic  work  on  philosophy. 
Worn  out  by  his  incessant  and  most  exhausting  literary 
labors  and  by  his  excesses  in  other  directions,  Avicenna 
died  in  June,  1037  A.  D.,  while  he  was  accompanying  the 
Emir  on  his  expedition  to  Hamadan.  His  tomb  may  still 
be  seen  in  the  latter  city. 

Neuburger,  from  whose  excellent  History  of  Medicine 
the  preceding  details  have  been  gleaned,  makes  the  state- 
ment that  the  treatise  in  which  Avicenna 's  clinical  expe- 
rience was  recorded  has  not  come  down  to  our  time,  and 
that,  consequently,  we  lack  the  means  of  estimating  just 
how  great  a  physician — just  how  close  a  clinical  observer 
and  how  wise  a  practitioner — he  really  was.  So  far,  how- 
ever, as  may  be  judged  from  the  evidence  furnished  by  the 
Canon,  Avicenna  was  not  the  equal,  in  all  practical  matters 
relating  to  medicine,  of  Haly  Abbas  and  of  Rhazes.  He 
was  perhaps  too  much  inclined  to  '4ook  at  bedside  phe- 
nomena through  the  spectacles  of  preconceived  theories.'* 
In  brief,  he  was,  first  and  foremost,  a  philosopher,  and  only 
in  a  subordinate  degree  a  physician,  although  a  most  excel- 
lent one.  In  Book  IIL,  where  he  discusses  certain  surgical 
procedures,  statements  are  made  which  justify  the  belief 
that  Avicenna  was  acquainted  with  intubation  of  the  larynx. 

Le  Clerc  mentions  six  other  Persians  who,  during  the 
tenth  century  of  the  present  era,  gained  more  or  less  dis- 
tinction as  physicians.  In  the  following  paragraphs  brief 
notices  are  given  of  each  of  these  men. 

Eben  el  Khammar,  born  in  942  A.  D.,  was  a  Christian 
and  an  excellent  practitioner.  He  was  well  versed  in  the 
science  of  medicine  and  a  writer  of  some  importance.  Date 
of  death  unknown. 

Abou  Sahl  el  Messihy,  who  was  also  a  Christian,  was  a 
contemporary  and  intimate  friend  of  Avicenna.  He  died 
in  1000  A.  D.    He  was  the  author  of  a  complete  and  very 


THE  ARAB  RENAISSANCE  223 

useful  summary  of  medicine,  entitled  ''Kitab  el  Meya"; 
and  the  Arab  historian  Ossaibiah  speaks  in  terms  of  ad- 
miration of  another  treatise  which  he  wrote  and  which 
bears  the  title,  '* Exposition  of  God's  wisdom  as  Mani- 
fested in  the  Creation  of  Man." 

Abou  Soleiman  Essedjestany,  commonly  called  '*E1 
Mantaky."  The  dates  of  his  birth  and  death  are  not 
known.  He  wrote  a  number  of  treatises,  and — among 
others — one  on  ''The  Organization  of  the  Human  Facul- 
ties." 

Aboul  Hassan  Ahmed  Etthabary,  a  native  of  Thabaris- 
tan,  in  the  Province  of  Khorassan.  He  was  employed  as 
a  physician  by  the  Emir  Rokn  eddoula  ben  Bou'ih,  and  is 
known  as  the  author  of  a  compendium  of  medicine  entitled : 
''Hippocratic  Methods  of  Treatment."  He  died  in  970 
A.  D. 

El  Comry  was  one  of  the  most  eminent  medical  prac- 
titioners of  his  time,  and  was  in  high  favor  with  the  royal 
household.  He  wrote  a  compendium  of  medicine  which 
bears  the  title  ''R'any  ou  Many,"  and  he  was  also  the 
author  of  a  treatise  on  the  causes  of  disease.  His  death 
occurred  toward  the  end  of  the  tenth  century  of  the  Chris- 
tian era. 

Alfaraby,  who  is  highly  commended  by  Avicenna,  should 
be  classed  among  the  philosophers  rather  than  among  the 
physicians.    He  died  in  950  A.  D. 

The  sixth  Persian  physician  of  some  distinction  men- 
tioned by  Le  Clerc  is  Ali  ben  el  Abbas — usually  spoken  of 
as  Haly  Abbas.  The  dates  of  his  birth  and  death  are  not 
stated  by  any  of  the  authorities,  but  it  is  known  that  he 
was  a  native  of  Ahouaz,  a  small  town  on  the  Karun  river, 
to  the  southeast  of  Bagdad,  and  that  he  was  still  living 
in  994  A.  D.  Haly  Abbas,  it  is  claimed,  was  the  first  med- 
ical writer  who  ventured  to  prepare  a  complete  and  sys- 
tematically arranged  Practice  of  Medicine.  He  gave  it  the 
title  of  Al-Maleky — ''The  Royal  Book," — and  dedicated  it 
to  the  Emir  Adhad-ad-Daula,  whose  private  physician  he 
was.  It  is  a  much  smaller  treatise  than  the  "Continens" 
of  Rhazes,  and  somewhat  more  complete  than  the  same 


224  GROWTH  OF  MEDICINE 

author's  shorter  work — the  * ' Mansoury. ' *  It  covers  the 
entire  field  of  medicine  and  is  distinguished  by  its  very 
practical  character.  It  was  first  translated  into  Latin  in 
1127  A.  D.  X\ 

Haly  Abbas,  in  one  of  ms  treatises,  speaks  of  Hip- 
pocrates in  the  following  terms :  *  *  Hippocrates,  who  is  the 
prince  of  the  medical  art  and  the  first  physician  who  ever 
wrote  a  book  on  this  art,  is  the  author  of  many  treatises 
on  all  sorts  of  medical  topics  ....  But  he  writes  in  such 
a  very  concise  manner  that  much  of  what  he  says  is  ob- 
scure, and  as  a  consequence  the  reader,  if  he  wishes  to 
understand  him,  is  obliged  to  seek  the  aid  of  a  commen- 
tary. ' ' 

Egypt. — The  dynasty  of  the  Fatimides — the  descendants 
of  Fatima  (the  daughter  of  Mohammed)  and  of  Ismael,  a 
great-grandson  of  Ali,  the  fourth  of  Mohammed's  succes- 
sors— reigned  over  Egypt  for  nearly  two  centuries  (10th 
to  12th  of  the  present  era),  and  they  showed  toward  the 
scientists  the  same  spirit  of  generosity  that  had  been 
manifested  toward  them  by  the  Abbasides  in  the  earlier 
part  of  their  reign.  In  970  A.  D.  Moez  Eddoula  drove  out 
the  reigning  family,  assumed  the  title  of  Caliph,  and 
founded  the  city  of  Cairo.  In  972  he  built  the  celebrated 
mosque  Al  Azhar  and  constructed,  as  a  sort  of  annex  to  it, 
a  school,  a  veritable  university,  where  ultimately  all  the 
sciences  were  taught.  It  throve  vigorously,  and  students 
flocked  to  it  in  great  numbers  from  all  quarters  of  the 
Moslem  empire.  During  the  eleventh  and  twelfth  centuries 
Egypt  was  once  more,  as  it  had  been  in  the  palmy  days  of 
Alexandria,  the  home  of  many  excellent  and  vigorous  insti- 
tutions of  learning.  Among  the  physicians,  however,  who 
received  their  education  in  medicine  at  Cairo  during  this 
long  period,  there  was  not  one  who  attained  great  eminence. 

At  the  end  of  the  eleventh  century  the  Crusaders,  under 
the  leadership  of  Godfrey  de  Bouillon  and  others,  made 
their  first  serious  attack  on  Palestine  and  Syria,  and  from 
that  time  onward,  for  about  two  centuries,  they  and  the 
different  armies  sent  out  successively  from  Europe  carried 
on  almost  constant  warfare,  which  Michaud  the   distin- 


.^ 


THE  ARAB  RENAISSANCE  225 

guished  French  historian  (about  1800  A.  D.)  calls  the 
product  of  a  pious  delirium.  Wars  of  religion  are  the 
most  savage  and  pitiless  of  all  wars,  says  Le  Clerc,  and 
this  was  emphatically  true  of  those  waged  by  the  Cru- 
saders. On  the  other  hand,  says  the  same  writer,  *Hhe 
tolerance  exhibited  at  that  period  by  the  Arabs  in  religious 
matters  is  a  well-attested  fact,  and  it  owes  its  origin  to 
the  circumstance  that  their  scientific  education  was  con- 
ducted by  Christians.  Of  Saladin's  fifteen  physicians 
two-thirds  were  either  Jews  or  Christians.  Cultivation 
and  good  training  were  the  characteristics  of  the  Arabs  at 
that  period  of  their  history,  whereas  fanaticism  and  brute 
force  were  the  distinguishing  features  of  the  European 
soldiers.  Several  hundred  thousand  adventurers  first 
ravaged  Europe  and  then  pounced  upon  Asia.  At  Antioch 
Godfrey  de  Bouillon  committed  all  sorts  of  excesses,  and 
then,  when  he  had  taken  Jerusalem,  he  massacred  70,000 
of  its  inhabitants — Jews  and  Musulmans.  Eighty  years 
later,  Saladin  retook  Jerusalem;  and,  with  the  exception 
of  a  comparatively  small  number,  he  allowed  all  of  his 
captives  to  go  free.  His  brother,  Malek  el  Adel,  paid  the 
ransom  of  2000  of  the  prisoners.  Contrast  these  fruits  of 
civilization  with  the  barbarism  of  the  European  conquerors 
under  Godfrey  de  Bouillon.  Another  result  of  the  Crusades 
was  this:  The  Franks  lost  a  good  deal  of  their  savagery 
through  contact  with  the  Arabs.  At  a  still  later  period 
Western  Europe  drew  a  large  part  of  her  supplies  of  knowl- 
edge from  Spain — i.e.,  from  the  Musulmans." 

Syria. — In  the  thirteenth  century  Damascus,  the  capital 
of  Syria,  assumed  considerable  importance  as  a  centre  of 
medical  activity.  Bagdad  and  Cairo  had  by  this  time  lost 
the  greater  part  of  their  attractiveness  for  those  who 
wished  to  perfect  their  knowledge  of  the  healing  art,  and 
the  vandalism  of  the  so-called  Soldiers  of  the  Cross  had 
put  an  end  for  many  years  to  come  to  all  hopes  of  making 
Constantinople  once  more  the  home  of  scientific  or  artistic 
effort.  There  was  one  branch  of  medical  practice,  however, 
in  which  the  Cairo  physicians  excelled  all  others — that, 
namely,  of  ophthalmology.    This  is  explained  by  the  well- 


226  GROWTH  OF  MEDICINE 

known  fact  that  at  all  periods  of  her  history  Egypt  has 
been  afflicted  with  ophthalmias  to  a  much  greater  degree 
than  any  of  the  other  countries  of  the  Mediterranean  basin. 
The  great  wealth  accumulated  in  Damascus,  the  large  num- 
ber of  hospitals  which  were  located  in  the  city,  and  the 
attractiveness  of  the  town  as  a  place  of  residence  undoubt- 
edly had  much  to  do  with  the  fact  that  it  attained  at  this 
period  so  great  popularity  as  a  centre  of  medical  activity. 

Spain. — During  the  tenth  century  of  the  present  era  the 
Moslem  reign  in  Spain  flourished  greatly  under  the  two 
enlightened  rulers  of  the  Ommiade  Dynasty — Abdur- 
rahman Ennasser  and  Hakem,  and  medicine  shared  fully 
in  this  prosperity.  During  Abdurrahman's  reign  the 
Emperor  Eomanus  at  Constantinople  sent  an  embassy  to 
Cordova  in  Spain,  and  among  the  gifts  which  they  took 
with  them  for  the  Prince,  was  a  copy  of  the  treatise  of 
Dioscorides  in  the  original  Greek,  illustrated  by  marvel- 
ously  beautiful  paintings  of  the  different  medicinal  plants. 
But  there  was  nobody  in  Cordova  at  that  time  who  could 
read  Greek.  Accordingly,  Abdurrahman  begged  the 
Emperor  to  send  him  a  man  who  was  familiar  with  both 
the  Greek  and  the  Latin  tongues,  and  it  was  in  answer  to 
this  request  that  the  monk  Nicholas  was  sent  to  Cordova 
(951  A.  D.).  Working  in  conjunction  with  several  of  the 
most  distinguished  physicians  of  that  city  he  succeeded  in 
identifying  nearly  all  of  the  plants  mentioned  by  Dios- 
corides. 

Among  the  physicians  of  Arab,  Persian  or  Jewish  ex- 
traction who,  during  the  eleventh  and  twelfth  centuries, 
practiced  their  profession  in  Spain  and  attained  consid- 
erable celebrity,  the  following  deserve  to  receive  special 
mention  here:  Abulcasis,  Avenzoar,  Averroes  and  Mai- 
monides. 

Abulcasis. — Abulcasis  is  universally  credited  with  being 
the  greatest  surgeon  of  whom  the  Arabs  may  rightfully 
boast.  He  was  born  at  Zahra  near  Cordova  in  936  A.  D., 
and  his  death  occurred  1013  A.  D.  Quite  early  in  his  pro- 
fessional career  (before  he  had  reached  his  twenty-fifth 
year)   he  was  appointed  one  of  Abdurrahman's  private 


THE  ARAB  RENAISSANCE  227 

physicians.  Although  he  owes  his  reputation  chiefly  to 
the  treatises  which  he  wrote  on  surgery  Abulcasis  was  also 
the  author  of  several  medical  works.  He  published  a  col- 
lection of  all  his  writings  under  the  title  of  ''The  Tesrif," 
which  is  divided  into  thirty  parts  or  books,  and  which — 
according  to  Lucien  Le  Clerc — constitutes  a  veritable  ency- 
clopaedia. During  the  course  of  the  twelfth  century 
Gerard  of  Cremona  translated  into  Latin  the  part  relating 
to  surgery;  it  is  not  known  at  what  time  or  by  whom  the 
remainder  of  the  collection  was  translated.  The  author's 
name  in  the  Latin  edition  is  given,  not  as  Abulcasis,  but 
as  Alsaharavius. 

During  the  lifetime  of  Abulcasis  his  writings,  and  espe- 
cially his  work  on  surgery,  were  not  very  highly  appre- 
ciated in  Spain.  This  was  largely  due  to  the  fact  that  the 
Mohammedan  inhabitants  of  that  country  did  not  look 
upon  surgery  with  any  degree  of  favor.  The  Arabs  of  the 
East  held  Abulcasis  in  much  greater  honor.  Guy  de 
Chauliac,  the  famous  French  surgeon  of  the  fourteenth 
century,  in  his  treatise  on  surgery,  quotes  Abulcasis  no 
less  than  two  hundred  times.  Le  Clerc,  in  the  course  of  his 
remarks  upon  the  value  of  the  surgical  treatise  written  by 
Abulcasis,  says:  ''This  book  will  always  be  considered, 
in  the  history  of  medicine,  to  represent  the  first  formal 
and  distinct  scientific  treatise  on  surgery."  At  the  same 
time,  the  prevailing  testimony  makes  it  appear  that  the 
book  contains  only  a  small  portion  of  original  matter,  a 
large  part  of  its  substance  having  been  borrowed  from 
the  work  of  the  Greek  author,  Paulus  Aegineta.  Its  chief 
merit  consists  in  the  orderly  and  very  clear  manner  in 
which  the  facts  are  presented,  and  doubtless  the  popu- 
larity of  the  book  was  materially  increased  by  the  fact 
that  many  of  the  instruments  required  for  the  different 
operations  were  illustrated  pictorially. 

Lucien  Le  Clerc  has  published  (Paris,  1861)  a  French 
translation  of  Abulcasis '  Treatise  on  Surgery,  and  on  page 
71  of  this  version  the  following  statement  will  be  found : — 

you  may  also  introduce  into  the  cannula  a  specially 

adapted  piston  in  copper,  or  a  stylet  the  end  of  which  is  armed 


■^- 


228  GROWTH  OF  MEDICINE 

with  cotton.  Then  fill  the  cannula  with  oil  or  some  other  suitable 
fluid,  introduce  into  one  end  the  stylet  armed  with  cotton,  and 
push  it  onward  until  the  liquid  enters  the  ear. 

Edouard  Nicaise,  commenting  on  these  words  in  his 
version  of  Guy  de  Chauliac's  La  Grande  Chirurgie  (page 
690),  says  that  they  constitute  the  first  reference,  thus  far 
discovered  in  medical  literature,  to  the  use  of  the  instru- 
ment known  as  a  syringe. 

Avenzoar. — ^Avenzoar  was  born  in  Seville,  in  the  south- 
ern part  of  Spain,  during  the  latter  part  of  the  eleventh 
century.  The  exact  date  is  not  known.  His  father  was 
a  physician  of  some  distinction,  and  his  son  also  attained 
considerable  eminence  in  the  same  profession.  According 
to  Neuburger,  Avenzoar  died,  at  an  advanced  age,  in  1162 
A.  D.,  and  was  buried  in  Seville. 

It  is  said  that  in  actual  practice  Avenzoar,  who  was  a 
man  of  some  wealth,  confined  himself  to  consultation  work. 
He  considered  it  beneath  the  dignity  of  a  physician  to 
prepare  drugs,  to  apply  leeches,  or  to  perform  certain 
surgical  operations — as,  for  example,  lithotomy;  but 
Le  Clerc  seems  disposed  to  believe  that  Avenzoar  did  not 
adopt  this  view  until  after  he  had  become  somewhat  cele- 
brated and  had  accumulated  a  fortune.  Neuburger  ranks 
him  next  to  Rhazes  as  a  clinical  observer  and  a  practitioner 
of  sound  common  sense,  and  he  speaks  of  his  great  medical 
work,  the  Teissir,  as  a  treatise  that  abounds  in  most  inter- 
esting histories  of  cases  of  disease.  Among  these  will  be 
found  the  account  of  an  attack  of  mediastinitis  which 
occurred  in  his  own  person,  and  which  ended  in  suppuration 
that  found  a  vent  for  its  products  by  way  of  one  of  the 
bronchi.^  As  this  disease  is  of  rare  occurrence,  and  as 
Freind's  account  of  the  attack  is  presumably  a  translation 
of  the  original  report  in  Arabic  made  by  Avenzoar,  its 
reproduction  here  may  be  interesting.  I  shall  take  the 
liberty  of  modernizing  the  text  very  slightly  and  of 
abbreviating  it  in  one  or  two  places. 

1  For  further  remarks  concerning  the  origin  of  the  Teissir  see  page  229. 


THE  ARAB  RENAISSANCE  229 

I  felt  some  pain  in  the  region  of  the  mediastinum  (the  membrane 
which  divides  the  thorax  in  the  middle)  while  I  was  on  a  journey. 
As  it  increased  a  cough  developed,  and  I  observed  that  my  pulse 
was  very  hard  and  that  I  had  an  acute  fever.  On  the  fourth  night 
I  took  away  a  pint  of  blood,  but  this  gave  me  very  little  relief. 
Being  obliged  to  travel  all  day  I  was  much  fatigued  when  I  retired 
at  night,  and  I  fell  asleep.  During  my  sleep  the  bandage  on  the 
arm  came  off,  and  when  I  awoke  I  found  the  bed  deluged  with 
blood  and  my  strength  greatly  exhausted.  The  next  day  I  began 
to  cough  up  a  sanious  matter,  and  my  mind  wandered  at  times. 
Gradually  all  the  symptoms  subsided  and  I  recovered  my  health. 
Although  I  partook  of  large  quantities  of  barley  water,  I  believe 
that  my  recovery  was  not  due  to  this,  but  rather  to  the  great  loss 
of  blood  which  I  had  experienced. 

Freind  adds  that  ''Avenzoar  not  only  takes  notice  of  an 
abscess  in  the  mediastinum,  but  in  the  pericardium  like- 
wise; which  I  don't  find  had  been  described  or  even  ob- 
served by  any  of  the  Greeks  or  Arabians :  and  there  is  no 
doubt  but  this  membrane  and  the  mediastinum  to  which 
it  is  contiguous,  are  subject,  as  well  as  the  pleura  and  lungs, 
to  an  inflammation." 

It  is  one  of  the  distinguishing  features  of  Avenzoar's 
character  that,  in  his  writings,  he  does  not  hesitate  to 
differ  from  his  predecessors  whenever  he  believes  that 
their  views  are  erroneous. 

Averroes. — Averroes  was  one  of  Avenzoar's  most  dis- 
tinguished pupils.  Indeed,  the  latter 's  famous  work,  the 
Teissir,  is  dedicated  to  Averroes.  Thanks  to  the  distin- 
guished French  historian  and  philosopher,  Ernest  Renan, 
our  knowledge  of  Averroes  has  been  greatly  expanded 
since  1852.  Averroes  was  born  at  Cordova  in  1126  A.  D. 
His  father  and  his  grandfather  had  both  held  the  office  of 
Cadhi  (Alcalde,  in  Spanish),  and  were  therefore  people 
of  importance  in  that  city.  His  studies  were  confined  at 
first  largely  to  philosophy,  and  when  he  reached  mature 
age  he  gained  a  great  reputation  as  the  commentator  and 
interpreter  of  the  writings  of  Aristotle.  Still  later  in  life 
much  of  his  attention  was  devoted  to  medicine,  and  he 
wrote  a  book  which  bears  the  title  **Kitab  al-kullidschat" 


230  GROWTH  OF  MEDICINE 

(General  principles  of  Medicine).  Among  the  physicians 
of  the  later  Middle  Ages  this  work  was  commonly  spoken 
of  as  the  **Colliget"  (from  kullidschat),  and  was  almost 
as  highly  esteemed  as  the  Canon  of  Avicenna.  The  idea 
of  writing  a  treatise  on  the  individual  diseases  was  first 
entertained,  among  Arabian  physicians,  by  Averroes;  but 
on  reflection  he  abandoned  the  idea,  and,  instead,  urged 
Avenzoar,  his  friend  and  former  instructor,  to  undertake 
the  work  in  his  place.  It  was  in  this  way  that  the  Teissir — 
the  finest  work  on  the  practice  of  medicine  produced  by  an 
Arab  writer — came  to  be  written. 

The  topics  treated  in  the  ''Colliget"  are  distributed 
throughout  the  seven  books  in  the  following  manner: — 

Book  I.  Anatomy. 

Book  II.  Health  (Physiology). 

Book  III,  Diseases, 

Book  IV.  Signs  or  Symptoms, 

Book  V.  Remedial  agents  and  Foods. 

Book  VI.  The  Preservation  of  Health. 

Book  VII.  The  Treatment  of  Diseases. 

Neuburger  speaks  of  the  ''Colliget"  as  a  fine  piece  of 
philosophical  writing,  but  adds  that  it  is  not  at  all  suited 
to  the  needs  of  the  practical  physician.  Indeed,  he  doubts 
whether  any  person  who  has  not  received  a  thorough  train- 
ing in  natural  philosophy — the  philosophy  of  Aristotle — 
would  be  able  to  follow  the  author  intelligently. 

Maimonides. — Maimonides,  who  is  ranked  by  Le  Clerc 
as  the  greatest  Jew,  after  Moses,  of  whom  the  history  of 
that  nation  makes  mention,  was  born  at  Cordova,  Spain, 
in  1135  A.  D.  In  early  youth  his  teachers  were  his  father 
and  a  disciple  of  Ebn  Badja.  At  the  age  of  thirteen,  and 
from  that  time  until  he  had  reached  his  thirtieth  year,  he 
was  obliged  under  the  pressure  of  circumstances,  to  pro- 
fess, at  least  outwardly,  the  faith  of  Islam.  Death  or 
banishment  was  the  only  alternative.  During  the  inter- 
vening period  of  seventeen  years  he  devoted  himself 
exclusively  to  his  studies.  In  1160  A.  D.  he  accompanied 
his  family  to  Fez,  Morocco,  and  five  years  later  he  settled 


TEE  ARAB  RENAISSANCE  231 

at  Fostath,  near  Cairo,  Egypt.  As  a  means  of  gaining  Ms 
livelihood  he  engaged  in  the  business  of  trafficking  in 
precious  stones,  continuing  his  studies  at  the  same  time 
and  carrying  on  a  certain  amount  of  medical  practice.  Not 
long  afterward  he  gained  the  favor  of  the  Vizir  El  Fadhl 
Beissany,  the  friend  of  Saladin,  Sultan  of  Egypt  and 
Syria,  and  was  by  him  appointed  one  of  the  Court  physi- 
cians. This  enabled  him  to  give  up  entirely  his  commercial 
business.  He  prospered  in  the  practice  of  medicine  and 
was  very  highly  esteemed  in  the  community  in  which  he 
lived.    His  death  occurred  in  1204  A.  D. 

Among  the  books  which  he  wrote  (generally  in  Arabic) 
on  medical  subjects,  the  following  deserve  to  receive  special 
mention : — 

I.     Commentary  on  the  Aphorisms  of  Hippocrates. 
II.     A  work  known  as  "Aphorisms  of  Maimonides"  (borrowed 

partly  from  Hippocrates  and  partly  from  Galen), 
HI.     Resume  of  the  writings  of  Galen. 
IV.     A  letter  relating  to  the  subject  of  personal  hygiene. 
V.-IX,     Treatises  on  asthma;  on  hemorrhoids;  on  venoms  and 
poisons  in  general ;  on  drugs ;  and  on  forbidden  articles 
of  diet. 
X.     A  translation  of  one  of  Avicenna's  works. 

Neuburger  speaks  in  very  favorable  terms  of  the  medical 
writings  of  Maimonides,  and  adds  that  he  also  wrote  a 
treatise  which  bears  the  title:  ** Guide  to  Those  in  Per- 
plexity"— a  work  which  aims  to  reconcile  reason  and  faith. 
The  book  has  been  translated  into  French  by  Munk;  and 
the  treatise  on  poisons  has  also  been  translated  into  the 
same  language  by  J.  M.  Rabbinowicz  (Paris,  1867). 

Speaking  of  the  remarkable  manner  in  which  philosophy 
and  medicine  had  flourished  in  Spain  during  the  tenth  and 
eleventh  centuries,  under  the  reigns  of  Haken  II.  and  his 
successors,  Ernest  Renan  says : 

The  love  of  science  and  of  things  beautiful  had  established,  in 
that  privileged  corner  of  the  world,  a  degree  of  tolerance  that  can 
scarcely  be  matched  in  modern  times.  Christians,  Jews,  Musul- 
mans  all  spoke  the  same  language,  sang  the  same  poems,  and  took 


232  GROWTH  OF  MEDICINE 

part  in  the  same  literary  and  scientific  studies.  All  the  barriers 
which  commonly  separate  men  were  thrown  down,  and  all  worked 
with  equal  zeal  in  behalf  of  our  common  civilization. 

"With  the  death  of  Averroes  (1198  A.  D.),  however,  Arab 
philosophy  lost  its  last  representative,  and  the  Koran 
resumed  its  full  authority  over  freedom  of  thought.  In  the 
succeeding  period  of  decadence  (thirteenth  century  of  the 
Christian  era)  there  were  no  physicians  of  first  importance, 
at  least  in  Spain  and  Persia ;  and  even  in  Egypt  and  Syria, 
over  which  reigned  at  this  time  the  enlightened  family  of 
Saladin,  the  leading  physicians  were  not  of  the  same 
calibre  as  the  men  whose  names  I  have  just  mentioned. 
Bagdad  and  Cordova  had  by  this  time  become  cities  of  less 
importance  than  Damascus,  and  botany  and  ophthalmology 
were  esteemed  of  greater  value  in  the  scheme  of  medical 
education  than  at  any  previous  time.  It  will  not  appear 
strange,  however,  that  medicine  should  have  stood  still 
during  this  later  part  of  the  Middle  Ages  if  we  bear  in  mind 
the  fact  that  warfare  was  then  such  a  frequently  occurring 
event  that  nobody  had  either  time  or  inclination  for  scien- 
tific studies.  The  invasions  of  the  Mongolians  and  the 
Crusaders  were  most  disturbing  factors. 

During  the  twelfth  century  of  the  present  era  there 
were — so  we  are  assured  by  Le  Clerc — women  physicians 
among  the  Arabs  in  Spain.  It  is  said,  for  example,  that 
Abou  Bekr,  a  distinguished  medical  practitioner  of  that 
period,  had  a  sister  who  was  well  trained  in  medicine,  and 
that  it  was  she  who  acted  as  midwife  at  all  the  confinements 
of  the  wives  of  the  Caliph  Almansur.  After  her  death  her 
niece  officiated  in  the  same  capacity  in  her  place.  There 
can  scarcely  be  any  reasonable  doubt  that,  almost  from 
time  immemorial,  women  as  well  as  men  have  taken  active 
part  in  the  practice  of  medicine. 

According  to  Puschmann,  Spain  possessed,  during  the 
twelfth  century  of  the  Christian  era,  seventy  public  libra- 
ries and  seventeen  institutions  for  instruction  in  the  higher 
branches  of  learning.  Among  the  residents  of  the  city  of 
Cordova  there  were,  during  the  same  period,  no  fewer  than 
one  hundred  and  fifty  authors;  and  the  smaller  cities  of 


THE  ARAB  RENAISSANCE  233 

Almeria,  Murcia  and  Malaga  could  each  claim  propor- 
tionally an  equally  large  number,  viz.,  fifty- two,  sixty-one 
and  fifty-three. 

The  Effects  of  the  Arab  Renaissance  as  a  Whole  upon 
the  Evolution  of  Medicine. — Although  the  series  of  events 
which  I  have  endeavored  to  sketch  here  in  brief  outlines 
reveals  an  extraordinary  degree  of  zeal  and  persistence 
on  the  part  of  the  Arab  rulers  and  their  subjects  to  endow 
the  nation  with  the  knowledge  and  skill  of  their  models,  the 
Greeks,  the  final  results  gained,  at  least  so  far  as  they  relate 
to  the  evolution  of  medicine  as  a  whole,  were  not  very 
great.  The  movement  lasted  for  five  or  six  centuries,  but 
nevertheless  only  a  few  relatively  unimportant  facts  were 
added  by  the  Arabs  to  the  stock  of  knowledge  which  was 
possessed  at  the  time  of  Galen's  death.  Alhazen's  bril- 
liant researches  in  the  eleventh  century  of  our  era  in  optics 
(more  particularly  with  reference  to  refraction)  paved  the 
way  for  a  more  perfect  knowledge,  in  modern  times,  of  the 
physiology  of  vision;  Geber,  who  lived  during  the  eighth 
century  of  the  Christian  era,  and  who  is  spoken  of  by 
Le  Clerc  as  '*  occupying  the  same  place  in  the  history  of 
chemistry  that  Hippocrates  does  in  the  history  of  medi- 
cine," laid  the  foundations  of  that  important  branch  of 
science;  Abulcasis  discovered  the  Medina  worm  {dracun- 
culus  Medinensis)  and  wrote  an  excellent  description  of 
the  pathological  effects  which  it  produces  when  it  lodges 
under  the  skin  of  a  man's  leg;  and,  finally,  our  pharma- 
copoeia was  enriched,  during  these  centuries,  by  the 
addition  to  it  of  a  number  of  new  drugs  and  pharmaceu- 
tical preparations.  These  are  among  the  more  important 
contributions  which  the  Arabs  made  to  the  general  stock 
of  medical  knowledge.  On  the  other  hand,  they  contributed, 
in  an  indirect  manner,  to  the  advance  of  the  science  of 
medicine.  From  the  thirteenth  century  onward,  for  a  long 
period,  the  Latin  language  was  destined  to  serve  as  the 
vehicle  by  means  of  which  all  scientific  knowledge  was  to 
be  spread  abroad  in  the  countries  which  are  now  known  as 
Italy,  Spain,  France,  Switzerland,  Germany,  Belgium  and 
Holland,  and  therefore  an  immense  amount  of  translating 


334  GROWTH  OF  MEDICINE 

had  to  be  done  before  the  works  of  Hippocrates,  Galen  and 
other  Greek  medical  authors  could  be  brought  within  reach 
of  the  physicians  of  these  different  countries.  At  that  late 
date  it  was  by  no  means  always  feasible  to  get  possession 
of  an  original  copy  of  one  of  these  classical  treatises,  and 
consequently  in  such  cases  it  became  necessary  to  employ 
an  Arabic  version  in  the  place  of  the  Greek  original. 
It  was  in  this  indirect  manner,  therefore,  that  the 
Mohammedan  Renaissance  contributed  most  effectively 
in  advancing  the  development  of  medical  science  in  general. 
One  cannot  dismiss  the  subject  of  Arabic  medicine  with- 
out calling  attention  once  more  to  the  spectacle  which  this 
remarkable  Renaissance  offers — that  of  an  entire  nation 
deliberately  working  to  educate  itself  up  to  the  level  of 
such  intellectual  and  artistic  giants  as  the  ancient  Greeks ; 
a  work  which  continued  with  unabated  zeal  throughout 
several  centuries  in  spite  of  obstacles  and  discouragements, 
and  which  never  ceased  for  a  moment.  It  is  a  spectacle 
without  parallel  in  the  world's  history. 


CHAPTER  XX 

HOSPITALS  AND  MONASTERIES  IN  THE  MIDDLE 

AGES 

Long  before  the  Christian  era  it  was  the  practice  among 
the  Greeks  to  make  suitable  provision  for  those  who,  by 
reason  of  poverty  or  illness,  were  unable  to  provide  for 
their  own  wants  or  to  secure  the  services  of  a  physician. 
Their  slaves,  for  example,  were  sent,  when  overtaken  with 
illness,  or  when  they  had  become  too  feeble  to  work,  to 
what  was  termed  Xenodochia — institutions  where  they 
received  kindly  care  and  such  medical  treatment  as  was 
necessary.  (Mommsen.)  In  strong  contrast  with  this 
humane  practice  stands  the  action  of  those  wealthy  Roman 
property  owners  who,  adopting  the  course  recommended 
by  Cato,  the  famous  censor  (96-46  B.  C),  ''sold  their  slaves 
when  they  became  old  and  feeble  or  ill,  as  they  would  old 
iron,  or  oxen  that  can  no  longer  be  utilized  for  work." 
This  cruel  practice  not  only  continued  throughout  a  period 
of  nearly  three  centuries,  but  apparently  became  more 
and  more  common,  for  we  are  told  that  the  Emperor 
Claudius  (268-270  A.  D.)  was  obliged,  in  order  to  mitigate 
the  evil,  to  issue  a  decree  that,  when  a  slave  was  driven 
out  of  the  house  by  his  owner,  he  should  be  declared  free. 

Hospitals  and  Other  Kindred  Institutions. — Toward  the 
end  of  the  fourth  century  of  the  present  era  the  first 
hospital  was  established  in  Rome  by  the  widow  Fabiola, 
a  member  of  the  distinguished  Fabian  family,  and  her 
example  induced  other  wealthy  Roman  ladies  to  found 
similar  institutions.  But  already  several  years  before  this 
time  the  influence  of  Christianity  had  made  itself  felt  so 
strongly  in  the  eastern  branch  of  the  Roman  Empire  that 


236  GROWTH  OF  MEDICINE 

the  Emperor  Julian,  who  had  previously  been  among  its 
most  bitter  opponents,  was  forced  to  say,  in  one  of  his 
letters : — 

Now  we  can  see  what  it  is  that  makes  these  Christians  such 
powerful  enemies  of  our  gods;  it  is  the  brotherly  love  which  they 
manifest  toward  strangers  and  toward  the  sick  and  the  poor,  the 
thoughtful  manner  in  which  they  care  for  the  dead,  and  the  purity 
of  their  own  lives. 

Moved  by  these  considerations,  he  decided  forthwith  to 
erect  hospitals  in  all  the  cities  of  the  empire.  We  do  not 
know  whether  he  acted  upon  this  resolution  or  not,  but  it 
is  a  matter  of  record  that  St.  Basil,  Bishop  of  Caesarea 
(370-379  A.  D.),  founded  in  that  city,  which  is  about  thirty 
miles  distant  from  Jerusalem,  a  settlement  composed  of 
numerous  dwellings  that  were  devoted  to  the  use  of  the 
poor  and  the  sick.  This  institution  was  managed  in  an 
admirable  manner,  a  special  corps  of  physicians  and  nurses 
being  assigned  to  the  duty  of  caring  for  its  inmates.  At 
Edessa,  the  capital  of  Northern  Mesopotamia,  another 
hospital  was  founded  in  375  A.  D.  The  date  of  the  estab- 
lishment of  the  celebrated  hospital  at  Djondisabour  in 
Persia,  of  which  mention  is  made  elsewhere  (see  page  204 
et  seq.),  is  not  known.  About  the  middle  of  the  sixth  cen- 
tury of  the  present  era,  Childebert  I.,  King  of  the  Franks 
and  son  of  Clovis,  founded  at  Lyons,  France,  the  Hotel- 
Dieu,  a  hospital  which  has  afforded  shelter  and  comfort 
to  thousands  of  human  beings  during  the  past  fourteen 
hundred  years,  and  which  is  in  active  operation  at  the 
present  time ;  a  hospital,  too,  which  has  served  as  a  training 
school  for  a  long  line  of  distinguished  physicians,  surgeons 
and  gynaecologists.  It  is  an  interesting  fact  that  Childe- 
bert intrusted  the  management  of  this  great  institution  to 
laymen  (instead  of  the  ecclesiastical  powers).  Finally, 
toward  the  end  of  the  sixth  century,  Bishop  Masona 
founded  in  Merida,  Spain,  a  hospital  in  which  Jews,  slaves 
and  freemen  were  received  and  treated  on  the  same  foot- 
ing ;  and  he  laid  down  the  rule  that  one-half  of  the  moneys 
and  other  gifts  received  by  the  church  was  to  be  devoted  to 


HOSPITALS  AND  MONASTERIES  237 

the  maintenance  of  this  institution.  The  list  of  hospitals 
and  other  charitable  organizations  which  were  established 
in  these  early  centuries  is  very  long,  and  it  reveals  the  fact 
that  in  every  known  land  there  existed,  throughout  these 
years,  a  strong  wish  to  give  aid  and  comfort  to  the  poor, 
the  sick  and  the  helpless.  The  Musulmans  appear  to  have 
been  as  zealous  as  the  Christians  in  promoting  works  of 
this  kind;  for  the  records  show  that  in  Bagdad,  Cairo, 
Damascus,  Cordova  and  many  of  the  other  cities  which 
were  under  their  control,  they  provided  ample  hospital 
accommodations.  Indeed,  one  of  the  largest  and  most 
perfectly  equipped  institutions  of  this  character  of  which 
the  history  of  the  Middle  Ages  furnishes  any  record,  was 
that  planned  and  constructed  at  Cairo,  Egypt,  in  1283 
A.  D.,  by  the  Sultan  El  Mansur  Gilavun.  While  it  was 
building,  the  workmen  employed  were  not  permitted  to 
engage  in  any  undertaking  for  private  citizens,  and  the 
Sultan  himself  never  failed  to  visit  the  spot  every  day 
during  the  progress  of  the  work.  The  site  chosen  was  that 
of  one  of  the  royal  palaces,  and  in  tearing  down  this 
structure,  in  order  to  make  room  for  the  new  building,  the 
workmen  brought  to  light  a  large  chest  filled  with  gold  and 
precious  stones,  the  value  of  which  was  sufficient  to  pay 
the  entire  expense  of  erecting  the  hospital.  Upon  the 
completion  of  the  building  and  the  equipment  of  its  spacious 
wards  in  the  most  perfect  manner  possible,  the  Sultan 
expressed  himself  in  the  following  terms: — 

I  have  founded  this  institution  for  people  of  my  own  class  and 
for  those  who  occupy  an  humbler  station  in  life — for  the  king  and 
for  the  servant,  for  the  common  soldier  and  for  the  Emir,  for  the 
rich  man  and  for  the  poor,  for  the  freeman  and  for  the  slave,  for 
men  and  also  for  women.  I  have  made  ample  provision  for  all 
the  remedial  agents  that  may  be  required,  for  physicians,  and  for 
everything  else  that  may  prove  useful  in  any  form  of  illness 

One  of  the  characteristic  features  in  the  management  of 
this  hospital,  says  Le  Clerc,  was  the  custom  of  giving  to 
each  of  the  poorer  inmates,  when  he  left  the  institution, 
five  pieces  of  gold,  in  order  that  he  might  be  spared  the 


238  GROWTH  OF  MEDICINE 

necessity  of  undertaking  immediately  work  of  an  exhausting 
character. 

Monasteries  in  Their  Relation  to  Medicine. — While  at 
first  these  institutions  were  designed  chiefly  as  places  of 
refuge  from  the  turmoil  of  the  world  and  from  the  violence 
of  frequent  warfare,  it  became  evident  in  the  course  of 
time  that  the  evils  incident  to  such  a  secluded  and  self- 
centered  life  hindered  rather  than  promoted  the  develop- 
ment of  those  particular  virtues  which  Jesus  Christ  urged 
his  followers  to  cultivate.  This  experience  led  to  the 
adoption  of  a  different  kind  of  cloister  life ;  and  so  it  came 
about,  as  stated  by  Neuburger,  that  in  529  A.  D.  Benedictus 
of  Nursia  founded,  at  an  isolated  spot  high  up  on  the  slope 
of  Monte  Cassino,  in  Campania,  Italy,  the  now  famous 
parent  monastery  of  the  Benedictine  Order.  According 
to  the  original  regulations  of  this  order,  the  monks  were 
obliged  to  perform  every  day  a  certain  amount  of  manual 
labor  as  well  as  devotional  exercises.  Nine  years  later 
Cassiodorus,  who  had  for  a  long  period  been  a  sort  of 
Secretary  of  State  under  Theodoric  the  Great  and  his 
successors,  became  a  monk,  and,  from  that  time  to  the  day 
of  his  death,  * '  devoted  all  his  energies  to  the  service  of  God 
and  the  advancement  of  science. ' '  He  secured  a  house  not 
far  from  the  Benedictine  monastery  on  Monte  Cassino, 
gathered  together  there  a  considerable  library,  and  made 
it  a  rule  of  the  place  that  the  copying  of  original  codices 
(the  majority  of  them  theological)  constituted  the  most 
useful  and  honorable  form  of  manual  labor.  A  few  years 
later,  this  smaller  establishment  was  made  a  part  of  the 
monastery  at  Monte  Cassino,  and  the  rule  just  mentioned 
was  thereafter  adopted  by  the  enlarged  institution.  But 
the  care  of  the  sick,  the  feeble,  and  children  was  the  par- 
ticular work  which  Benedictus,  the  founder  of  this  institu- 
tion, had  most  at  heart.  Cassiodorus  went  even  farther 
and  urged  upon  the  brethren  the  desirability  of  studying 
the  healing  art  and  of  utilizing,  for  this  purpose,  the  works 
of  ancient  medical  authors. 

Learn  all  you  can,  he  said,  about  the  characteristics  of  different 
plants  and  about  the  methods  of  preparing  medicinal  mixtures, 


HOSPITALS  AND  MONASTERIES  239 

but  set  all  your  hopes  upon  the  Lord  who  is  the  preserver  of  our 
lives.  In  your  search  for  knowledge  about  drugs  consult  the 
herbarium  of  Dioscorides,  who  has  described  and  pictured  the 
different  herbs  with  great  accuracy.  Afterward  read  Latin  trans- 
lations of  the  works  written  by  Hippocrates  and  by  Galen,  par- 
ticularly the  latter 's  treatise  on  therapeutics,  the  one  which  he 
addresses  to  the  philosopher  Glaucon;  and,  in  addition,  study  the 
work  of  Caelius  Aurelianus  on  the  practice  of  medicine,  that  of 
Hippocrates  on  medicinal  plants  and  methods  of  treatment,  and 
some  of  the  other  writings  on  medicine  which  you  will  find  in  my 
library  and  which  I  have  left  behind  me  for  the  benefit  of  my 
brethren  in  this  institution. 

The  advice  given  by  Cassiodorus  was  heeded,  not  only 
by  those  to  whom  it  was  addressed,  but  also  by  many  suc- 
ceeding generations  of  monks.  Even  at  the  present  time, 
says  Neuburger,  the  books  which  Cassiodorus  recommended 
are  still  to  be  found,  either  in  the  form  of  original  manu- 
script copies  or  in  that  of  translations,  in  the  library  of 
the  parent  institution.  Furthermore,  when  it  is  remem- 
bered how  large  a  number  of  affiliated  Benedictine  monas- 
teries were  established  in  different  parts  of  Europe,  it  will 
readily  be  appreciated  that  the  good  accomplished  by  the 
advice  which  Cassiodorus  gave  must  have  been  very  great. 

Among  the  later  abbots  of  Monte  Cassino  there  were 
three  who  attained  considerable  distinction  as  physicians. 
They  were  Bertharius,  who  wrote  two  treatises  on  medical 
topics;  Alphanus  II.,  Archbishop  of  Salerno,  who  was 
celebrated  both  as  a  physician  and  as  a  poet ;  and  Desiderius 
(1027-1087  A.  D.),  who  was  skilled,  not  only  in  medicine, 
but  also  in  jurisprudence,  and  who  was  elected  Pope  under 
the  title  of  Victor  III.  The  monastery  attained  the  height 
of  its  celebrity  at  the  time  when  Constantinus  the  African 
became  one  of  its  regular  members.  Although  Constan- 
tinus was  a  native  Arab  (born  at  Carthage  about  1018 
A.  D.),  he  became  converted  to  Christianity  quite  early  in 
life.  It  is  said  that  he  was  a  great  traveler  as  well  as  a 
great  scholar,  and  that  he  devoted  several  years  to  visiting 
foreign  lands — Babylonia,  India,  Egypt  and  Ethiopia.  It 
was  in  this  way  that  he  became  so  well  versed  in  the  Ian- 


240  GROWTH  OF  MEDICINE 

guages  of  the  East.  Upon  visiting  Spain  as  a  fugitive 
from  his  native  city,  he  took  with  him  several  of  the  works 
of  Hippocrates  and  Galen,  and  in  course  of  time  translated 
them  into  Latin.  Finally,  he  accepted  the  position  of 
secretary  to  Robert  Gruiscard,  the  first  Norman  Duke  of 
Calabria  and  Apulia,  who  appears  to  have  selected  Salerno 
as  his  place  of  residence.  At  the  same  time  he  became  one 
of  the  teachers  at  the  medical  school  of  that  city,  and  served 
in  this  capacity  for  a  certain  length  of  time ;  but,  at  the  end 
of  a  few  years,  he  was  formally  accepted  by  the  Abbot 
Desiderius  as  a  member  of  the  Monte  Cassino  community, 
and  it  was  here  that  he  did  the  larger  part  of  his  literary 
work.  His  death  occurred  in  1087  A.  D.,  the  same  year  in 
which  the  Abbot  Desiderius — or,  rather,  Pope  Victor  III. — 
died. 

Constantinus  was  a  prodigious  worker,  but  it  is  doubtful 
whether  he  did  anything  of  an  original  character.  Not  a 
few  of  the  treatises  which  were,  at  that  time,  credited  to 
him  as  original  productions,  are  now  known — thanks 
largely  to  the  researches  of  the  great  French  historian  and 
linguist,  Daremberg — to  be  simply  translations  from  the 
Arabic. 

It  is  believed  by  some  authorities  that  at  Monte  Cassino 
medicine  was  taught  to  laymen  as  well  as  to  those  who  were 
preparing  to  become  members  of  the  Benedictine  Order 
of  monks.  It  is  not  likely,  however,  that  this  was  done 
to  any  great  extent,  as  much  better  facilities  for  acquiring 
knowledge  of  medicine  were  available  at  Salerno  in  the 
near  neighborhood. 

In  some  parts  of  Gaul,  in  the  early  Middle  Ages,  physi- 
cians received  very  little  consideration;  indeed,  to  us 
moderns  it  seems  strange  that  any  one  should  have  pos- 
sessed sufiicient  courage  to  accept  the  responsibility  of 
prescribing  for  a  member  of  one  of  the  royal  families.  It 
is  related  by  Neuburger,  on  the  authority  of  Gregory  of 
Tours '  History  of  the  Franks,  that  when  Austrichildis,  the 
wife  of  King  Guntram  (sixth  century  A.  D.),  was  ill  with 
the  plague  and  perceived  that  her  death  was  near  at  hand, 
she    sent   for   her   husband    and    extracted   from   him   a 


HOSPITALS  AND  MONASTERIES  241 

promise  that  he  would  behead  the  two  physicians,  Nicolaus 
and  Donatus,  who  had  treated  her  and  whose  prescriptions 
had  failed  to  effect  a  cure.  Her  wish  was  carried  out,  in 
order — as  the  statement  reads — *Hhat  her  Majesty  might 
not  enter  the  Realm  of  the  Dead  entirely  alone."  Many 
centuries  later,  however,  when  civilization  had  certainly 
advanced  far  beyond  the  stage  which  it  had  reached  in  Gaul 
in  the  sixth  century  of  the  present  era,  there  were  instances 
in  which  able  and  conscientious  physicians  were  subjected 
to  equally  cruel  treatment  for  their  failure  to  effect  a  cure. 

It  was  at  about  this  same  period,  as  is  amply  verified 
by  the  statements  made  by  Bishop  Gregory  of  Tours,  that 
faith  in  the  power  of  saintly  relics  to  heal  diseases  became 
almost  universal.  So  great  was  the  effect  produced  upon 
the  minds  of  the  people  by  the  public  display  of  these 
objects — bones  of  saints,  portions  of  their  grave-stones, 
etc. — that  a  large  number  of  marvelous  cures  were  reported 
as  the  result  of  such  displays;  and  doubtless — so  great  is 
the  power  of  suggestion  over  the  human  mind — many  of 
these  reports  were  true.  A  century  later  (673-735  A.  D.), 
the  Venerable  Bede,  author  of  the  famous  work  entitled 
*' Ecclesiastical  History  of  the  English  Nation,"  gave,  in 
the  course  of  his  narrative,  an  account  of  a  case  of  aphasia 
in  which  * '  a  remarkable  cure  was  effected ' ' ;  and,  although 
he  mentions  a  course  of  ** systematic  exercises  in  speaking" 
as  the  means  used  to  effect  that  cure,  he  attributes  it  to 
supernatural  causes  and  not  to  the  practical  treatment 
adopted.  He  also  describes  some  of  the  epidemics  of  his 
time,  and  gives  most  interesting  though  brief  accounts  of 
the  methods  of  treatment  employed  by  the  priests  and  the 
monks. 

During  the  ninth  and  tenth  centuries,  as  we  learn  from 
the  very  full  descriptions  given  by  Neuburger  in  his  History 
of  Medicine,  much  zeal  was  manifested  by  the  monks  at 
St.  Gall  in  Switzerland,  at  Reichenau  in  Saxony,  and  at 
Fulda,  in  Hesse  Nassau,  in  the  study  of  the  different 
branches  of  knowledge,  medicine  included.  The  following 
are  the  names  of  those  monks  who  attained  the  greatest 
distinction  in  this  work:    Hrabanus  Maurus,  Abbot  of  the 


242  GROWTH  OF  MEDICINE 

Fulda  Monastery,  afterward  Archbishop  of  Mayence,  and 
the  author  of  an  encyclopaedia  in  which  the  science  of 
medicine  receives  quite  full  consideration;  and  Walahfrid 
Strabo,  a  pupil  of  Maurus,  Abbot  of  Reichenau,  and  the 
author  of  a  treatise  in  verse  on  medicinal  plants. 


CHAPTER  XXI 

MEDICAL  INSTRUCTION  AT  SALERNO,  ITALY,  IN 
THE  MIDDLE  AGES 

The  date  of  origin  of  the  Medical  School  at  Salerno  is  not 
known,  but  such  evidence  as  we  possess  shows  without  a 
doubt  that  already  in  the  earliest  part  of  the  Middle  Ages 
some  sort  of  facilities  for  studying  medicine  were  provided 
in  that  little  town — the  Civitas  Hippocratica,  as  it  was 
called  at  a  later  period.  It  seems  to  be  the  general  impres- 
sion, says  Daremberg,  that  during  those  early  centuries 
only  ignorance  and  superstition  prevailed  in  Italy  and 
Gaul ;  in  other  words,  that  all  desire  for  scientific  research 
had  vanished,  and  that  there  no  longer  existed  such  a  thing 
as  the  regular  practice  of  medicine.  This  impression,  he 
adds,  is  erroneous.  History  shows  that  schools  modeled 
after  those  established  by  the  Merovingian  and  Carlo- 
vingian  kings  (448-639  A.  D.),  existed  up  to  as  recent  a 
date  as  the  middle  of  the  seventh  century,  and  that  subse- 
quently the  bishops  organized  the  teaching  in  such  a  manner 
that  it  should  be  entirely  under  their  control.  As  time 
went  on,  however,  the  schools  assumed  a  more  public 
character,  although  the  actual  teaching  was  still  carried 
on  in  the  cloisters  and  church  edifices.  It  is  well  known, 
furthermore,  that  the  chief  of  the  Ostrogoths,  Visigoths 
and  Lombards — the  so-called  Barbarians,  who  at  that  time 
occupied  these  parts  of  Europe  as  conquerors — showed 
themselves  on  many  an  occasion  to  be  the  enlightened 
protectors  of  public  instruction  and  the  enthusiastic 
admirers  of  classical  literature  and  science. 

At  Milan  there  is  preserved  a  manuscript  which  furnishes  satis- 
factory proof  that  the  writings  of  Hippocrates  and  Galen  were 


244  GROWTH  OF  MEDICINE 

made  the  subject  of  public  teaching  at  Ravenna  toward  the  end 
of  the  eighth  century  of  the  present  era And  the  tran- 
scribing of  medical  manuscripts  was  known  to  be  carried  on  at  the 
Monastery  of  St.  Gall,  in  Switzerland,  during  the  eighth  cen- 
tury  It  is  plain,  therefore,  that  throughout  those  extensive 

regions  which  previously  had  formed  a  part  of  the  Roman  Empire, 
but  which  during  the  Middle  Ages  were  under  the  dominion  of 
Barbarian  kings,  there  was  never  an  entire  lack  of  physicians,  or 
of  medical  knowledge,  or  of  facilities  for  teaching  medicine. 
(Daremberg.) 

In  the  light  of  these  statements  it  is  easy  to  believe  that 
the  original  development  of  the  Medical  School  at  Salerno 
was  a  perfectly  natural  event  like  that  of  the  founding  of 
any  of  the  medical  schools  of  a  more  recent  date.  The 
remarkably  healthy  and  singularly  attractive  character  of 
the  spot  where  the  town  of  Salerno  is  located ;  the  proximity 
of  mineral  springs ;  the  comparatively  short  distance  which 
separated  it  from  such  important  centres  of  population  as 
Naples  and  the  cities  of  the  Island  of  Sicily,  and  from  the 
famous  Benedictine  Monasteries  at  La  Cava,  Beneventum 
and  Monte  Cassino;  and  the  circumstance  that  a  Ducal 
Court  was  established  there — all  these  are  facts  which 
amply  explain  both  why  a  medical  school  was  founded  here 
rather  than  at  some  other  spot,  and  why  physicians  of 
exceptional  ability  were  easily  induced  to  make  the  place 
their  home.  At  no  time  in  the  history  of  the  school,  it  is 
important  to  state,  do  the  church  authorities  appear  to  have 
been  in  control  of  its  affairs.  At  most,  one  or  two  of  the 
monks  seem  to  have  taken  part  in  the  teaching  for  limited 
periods  of  time ;  but  in  its  main  characteristics  the  school 
may  truthfully  be  described  as  an  institution  created  and 
managed  by  physicians  for  the  advancement  of  medical 
science  and  the  best  interests  of  the  profession  as  a  whole.* 
The  organization  of  hospitals  and  their  utilization  for 
purposes  of  clinical  instruction  must  have  been  the  most 
important  events  which  followed  next  in  order.    It  is  only 

*  According  to  tradition  the  medical  school  at  Salerno  was  founded  by  four 
physicians — Adela,  an  Arab;  Helinus,  a  Jew;  Pontus,  a  Greek;  and  Salernus, 
a  Latin. 


MEDICAL  INSTRUCTION  AT  SALERNO      245 

upon  this  assumption  that  we  can  satisfactorily  explain 
why,  for  many  years  in  succession,  physicians  traveled  all 
the  way  from  France,  Germany  and  England  to  Salerno. 
They  were  eager  to  gain  additional  knowledge  of  medicine, 
and  clinical  instruction  afforded  the  only  sure  way  of 
obtaining  it ;  but  instruction  of  this  kind  was  nowhere  else 
to  be  obtained  at  that  remote  period,  and  consequently  men 
of  this  earnest  and  ambitious  stamp  were  compelled  to 
make  the  long  journey  and  to  incur  the  expense  and  the 
risk  incident  to  such  a  trip.  As  a  further  evidence  of  the 
value  which  the  physicians  of  the  later  Middle  Ages  set 
upon  the  writings  of  the  teachers  at  Salerno,  the  fact 
deserves  to  be  mentioned  that,  toward  the  end  of  the  twelfth 
century  and  all  through  the  thirteenth  and  fourteenth 
centuries,  these  works  were  frequently  quoted. 

But  the  ability  and  learning  of  the  Salerno  physicians 
were  highly  appreciated  by  the  public  at  large  as  well  as 
by  their  confreres  in  other  lands ;  for  many  people  of  wealth 
and  of  high  social  standing  visited  Salerno  for  the  purpose 
of  consulting  them.  Among  the  number  were  Adalberon, 
Bishop  of  Verdun,  France,  who  journeyed  thither  in  984 
A.  D.,  but  failed  to  obtain  the  relief  which  he  required; 
Desiderius,  the  Abbot  of  Monte  Cassino;  Bohemund,  the 
son  of  Duke  Robert  Guiscard ;  and  William  the  Conqueror, 
afterward  King  of  England.  The  two  last  named  remained 
for  some  time  in  Salerno,  in  order  to  secure  needed  treat- 
ment for  the  wounds  which  they  had  received  in  battle. 

Toward  the  end  of  the  tenth,  or  at  the  beginning  of  the 
eleventh,  century  the  teaching  of  medicine  at  Salerno  began 
to  assume  the  character  of  regularly  organized  work.  The 
names  of  the  men  and  women  who  conducted  it — for  there 
were  women  as  well  as  men  in  the  corps  of  teachers — are 
mentioned  in  various  contemporaneous  documents  which 
have  come  down  to  our  time.  They  are  as  follows: 
Petroncellus,  Gariopuntus,  Alphanus,  Bartholomaeus, 
Cophon,  Trotula,  John  and  Matthew  Platearius,  Abella, 
Mercuriade,  Costanza  Calenda,  Rebecca  Guarna,  Aflflacius, 
Maurus,  Musandinus  and  many  others.  According  to 
Puschmann,  the  list  of  physicians  who,  during  the  exist- 


246  GROWTH  OF  MEDICINE 

ence  of  the  Medical  School  at  Salerno, — a  period  of  nearly- 
one  thousand  years, — acted  as  teachers  in  the  institution, 
comprised  no  less  than  340  names.  The  presence  of  several 
women  among  the  instructors  of  this  school,  and  the  great 
esteem  in  which  they  were  held  by  the  men  of  that  time, 
both  for  their  ability  as  practitioners  and  for  the  excellence 
of  the  treatises  which  they  wrote,  furnish  strong  confirma- 
tion of  the  statement  which  Plato  makes  in  his  work 
entitled  ' '  The  Eepublic, ' '  and  which  I  have  already  quoted 
in  one  of  the  earlier  chapters,  viz. :  * '  For  women  have  as 
pronounced  an  aptitude  as  men  for  the  profession  of 
medicine."  And,  if  further  evidence  of  the  correctness  of 
Plato's  opinion  were  needed,  the  success  attained  by 
women  physicians  during  the  past  thirty  or  forty  years  in 
the  United  States  of  America  might  be  cited. 

To  the  general  statement  made  above  I  may  with 
advantage  add  a  few  details  regarding  both  the  individual 
physicians  at  Salerno  and  the  books  which  they  wrote. 
During  recent  years,  thanks  to  the  researches  of  Henschel, 
de  Eenzi  and  Piero  Giacosa,  our  knowledge  of  these  matters 
has  been  greatly  enlarged.  In  1837  Henschel  found,  in  the 
library  at  Breslau,  Germany,  a  manuscript  collection  of 
Salerno  medical  treatises  ('* Compendium  Salernitanum") 
dating  back  as  far  as  the  latter  part  of  the  twelfth  century 
of  the  present  era.  De  Eenzi,  working  in  association  with 
Daremberg  and  Baudry  de  Balzac,  succeeded  in  collecting 
from  the  different  libraries  of  Italy  quite  a  large  number 
of  additional  Salerno  treatises,  all  of  which  have  since  been 
published  under  the  title  ^^Collectio  Salernitana,  ossia 
documenti  inediti  e  trattati  di  medicina  appartenenti  alia 
scuola  medica  Salernitana'^  (5  vols.,  Naples,  1852-1859). 
Finally,  Piero  Giacosa  has  added  to  this  stock  of  Salerno 
writings  by  the  publication  (Turin,  1901)  of  a  work  which 
bears  the  title  '^Magistri  Salernitani  nondum  editi  etc.'' 
Beside  the  treatises  to  be  found  in  these  three  collections 
there  is  one  other  which,  according  to  Neuburger,  contrib- 
uted more  than  all  the  others  combined  to  the  fame  of  the 
Medical  School  of  Salerno.  The  title  of  this  extraordinary 
work  is:  *' Regimen  sanitatis  Salernitanum." 


MEDICAL  INSTRUCTION  AT  SALERNO      247 

The  Salernian  writings,  it  appears,  may  readily  be 
divided  into  two  groups — those  of  the  earlier  and  those  of 
the  later  epoch  of  this  famous  school.  The  treatises  which 
belong  to  the  older  epoch  are  written  in  the  degraded  Latin 
of  the  Middle  Ages,  and  seem  to  have  been  composed 
entirely  for  didactic  purposes.  In  the  main  they  are 
compilations  of  still  earlier  Graeco-Latin  works,  but  here 
and  there,  especially  in  the  parts  which  relate  to  thera- 
peutics, evidences  of  a  certain  m'easure  of  originality  are 
discoverable.  The  pathology  adopted  shows  a  hodge-podge 
of  the  humoral  doctrine  and  that  of  the  Methodists. 

The  chief  representative  of  this  early  epoch  is  Gario- 
pontus  (first  half  of  the  eleventh  century),  whose  treatise 
on  special  pathology  and  therapeutics — entitled  ^^Passion- 
arius ' ' — was  very  popular  for  a  long  period  of  years.  Next 
in  order  comes  Petroncellus,  whose  ^^Practica"  calls  for 
no  special  comment.  Of  the  works  of  Alphanus,  John 
Platearius  (the  elder)  and  Cophon  (the  elder),  we  possess 
only  fragments.  Trotula,  who  lived  about  1059  A.  D.  and 
was  believed  to  be  the  wife  of  John  Platearius  I.,  attained 
greater  celebrity  than  any  of  those  just  mentioned.  She 
was  related  to  Eoger  I.,  Count  of  Sicily,  and  was  therefore 
probably  of  Norman  extraction,  and  she  was  considered  by 
her  contemporaries  to  be  very  learned  {^^ sapiens  mat- 
rona^^).^  Her  writings,  which  are  quite  numerous,  are 
frequently  quoted  by  later  authors,  this  being  especially  true 
of  her  work  on  diseases  of  women.  The  four  other  women 
who  took  an  active  and  creditable  part  in  the  work  of  the 
Salerno  Medical  School  also  wrote  treatises  on  various  sub- 
jects: Abella,  on  '* Black  Bile"  (written  in  verse) ;  Mercu- 
riade,  on  ** Pestilential  Fever,"  and  also  on  ''The  Treatment 
of  Wounds";  and  Rebecca  Guarna,  on  ''Fevers."  In  the 
case  of  Costanza  Calenda,  the  daughter  of  the  Dean  of  the 
medical  school  and  a  woman  remarkable  for  her  wisdom 
as  well  as  for  her  great  beauty,  no  record  of  the  treatises 
which  she  wrote  appears  to  have  been  preserved. 

The  later  epoch  of  the  literature  created  by  the  Medical 
School  of  Salerno  begins  about  the  year  1100  of  the  present 

1  Perhaps  the  French  title  ' '  sage-f emrae ' '  originated  from  this. 


248  GROWTH  OF  MEDICINE 

era,  after  the  Latin  translations  and  compilations  made  by 
Constantinus  the  African  had  taught  the  physicians  who 
were  then  at  the  head  of  affairs  something  about  the 
medicine  of  the  Arabs,  and  had,  at  the  same  time,  through 
the  latter  medium,  brought  to  their  attention  afresh  the 
teachings  and  practice  of  the  ancient  Greeks.^  Among  the 
works  of  the  latter  character — works  which  in  their  Latin 
dress  proved  most  valuable  to  the  Salerno  physicians — are 
the  following:  "The  Aphorisms  of  Hippocrates"; 
"Galen's  Ars  Parva^^  (Mikrotechne) ;  and  the  same 
author's  "Commentaries  on  the  Hippocratic  Writings." 

John  Afflacius,  a  monk  who  lived  during  the  latter  half 
of  the  eleventh  century  of  the  present  era^  was  one  of  the 
pupils  of  Constantinus.  His  treatise  "On  Fevers," 
according  to  Neuburger,  contains  ample  evidence  of  the 
author's  ability  as  a  clinical  observer. 

Something  still  remains  to  be  said  concerning  Bartholo- 
maeus,  Cophon  the  Younger,  John  Platearius  the  Younger 
and  Archimathaeus.  They  have  already  been  mentioned 
in  the  list  of  authors  whose  writings  contributed  materially 
to  the  celebrity  of  the  Medical  School  of  Salerno,  and  it  is 
now  only  necessary  to  furnish  a  few  particulars  with 
regard  to  their  lives  and  the  nature  of  the  work  which  they 
accomplished. 

Bartholomaeus  wrote  a  treatise  (entitled  "Prac^ica") 
on  the  practice  of  medicine  as  taught  by  Hippocrates, 
Galen,  Constantinus  and  the  Greek  physicians.  Its  endur- 
ing popularity  is  evidenced  by  the  facts  that  it  was  trans- 
lated at  an  early  period  into  several  languages  and  that 
portions  of  its  text  are  often  quoted  by  later  authors.  The 
book  contains  ample  evidence  that  its  author  was  a  very 

2  There  can  be  no  question,  says  Neuburger  (in  agreement  with  Daremberg), 
about  the  truth  of  the  statement  that  Constantinus  allowed  the  authorship  of 
several  of  the  treatises  issued  at  Salerno  under  his  name  to  be  attributed  to 
himself — as,  for  example,  the  "Liber  Pantegni"  (Pantechni) ,  which  is  in 
reality  the  "Liber  Begalis"  of  Haly  Abbas;  the  " Pieticum,"  which  is  funda- 
mentally the  work  of  fbn-al-Dschezzar;  the  "De  Oculis,"  which  is  based  upon 
Honein  ben  Ischak's  treatise  on  opthalmology;  and  still  other  works  which 
it  is  not  necessary  to  specify. 


MEDICAL  INSTRUCTION  AT  SALERNO      249 

close  observer  and  a  physician  who  strove  to  make  accurate 
diagnoses. 

Cophon  the  Younger  (about  1100  A.  D.)  was  the  author 
of  two.  works :  a  treatise  on  anatomy  which  bore  the  title 
^'Anatomia  Porci,"  and  one  on  the  practice  of  medicine 
{^^ Practical ^).  The  ancients,  it  is  stated,  selected  a  pig  for 
purposes  of  anatomical  study  ''because  its  internal  organs 
present  a  very  close  resemblance  to  those  of  the  human 
being."  Both  books  are  written  in  a  clear  and  simple 
style. 

John  Platearius  the  Younger  was  the  author  of  a  work 
on  internal  medicine  {^^Practica  Brevis^^)  and  also  of  one 
on  the  subject  of  urine  {^^Regulae  Urinarum^^). 

Archimathaeus  wrote  and  published  three  treatises :  one 
on  ''Urines,"  another  on  practical  medicine  {^' Practical ^), 
and  the  third  on  ' '  The  Demeanor  which  a  Physician  should 
Observe  when  he  Visits  a  Sick  Person"  ("De  Aventu 
MedicV').  The  latter  treatise,  says  Neuburger,  is  "a 
mixture  of  piety,  artlessness,  and  slyness ;  but  it  furnishes 
a  capital  picture  of  the  carefully  regulated  behavior  of  the 
mediaeval  physician  at  the  patient 's  bedside,  of  the  manner 
in  which  he  conducted  his  examination  of  the  case,  and 
of  his  intercourse  with  the  household  as  well  as  with  the 
sick  person." 

In  addition  to  the  treatises  referred  to  above, — treatises 
which  are  known  to  have  been  written  by  the  authors  to 
whom  I  have  credited  them, — the  Collectio  Salernitana 
contains  several  of  which  the  authorship  is  not  known. 
One  of  these,  which  bears  the  title  "De  Aegritudinum 
Curatione,"  is  reputed  to  furnish  a  better  account  of  the 
special  pathology  and  therapeutics  taught  at  the  Medical 
School  of  Salerno  during  the  height  of  its  celebrity  than 
is  to  be  found  in  any  of  the  other  treatises.  In  one  part 
of  the  book — that,  namely,  in  which  local  affections  are 
discussed — the  anonymous  author  gives  in  succession  the 
opinions  held  by  the  seven  leading  teachers  of  the  school 
(Platearius  II.,  Cophon  II.,  Petronius,  Afflacius,  Bartholo- 
maeus,  Ferrarius  and  Trotula)  with  regard  to  each  one  of 


250  GROWTH  OF  MEDICINE 

a  certain  number  of  local  diseases;  thus  enabling  the 
reader  to  obtain  a  very  fair  idea  of  what  was  the  condition 
of  medical  science  at  Salerno  during  the  twelfth  century 
of  the  present  era. 

The  famous  didactic  poem  known  as  the  ''School  of 
Salerno"  {Schola  Salernitana)  and  also  as  the  ''Code  of 
Health  of  the  School  of  Salerno"  {Regimen  Sanitatis 
Salernitanum),  was  composed  originally  about  1100  A.  D. 
It  was  clearly  intended  in  the  first  instance  for  the  guidance 
of  laymen  in  matters  relating  to  diet,  the  conservation  of 
health  and  the  prevention  of  disease;  but  from  time  to 
time,  as  the  years  rolled  on,  there  were  added  to  it  several 
sections  which  changed  materially  the  character  of  the 
poem.  From  a  mere  code  of  health  it  became  eventually 
a  fairly  complete  cyclopaedia  of  medicine  in  versified 
form;  the  number  of  the  verses  having  increased  fully 
tenfold  during  this  long  period.  The  poem,  in  its  latest 
state,  is  arranged  in  ten  principal  sections,  as  follows: 
Hygiene  (8  chapters) ;  materia  medica  (4  chapters) ; 
anatomy  (4  chapters) ;  physiology  (9  chapters) ;  etiology 
(3  chapters) ;  significance  of  different  signs  (24  chapters) ; 
pathology  (8  chapters) ;  therapeutics  (22  chapters) ; 
nosology  (20  chapters) ;  and  the  practice  of  medicine  as 
actually  experienced  (5  chapters). 

The  work  has  been  translated  into  nearly  every  modern 
language,  and,  according  to  an  estimate  which  was  made 
in  1857,  there  are  in  existence  no  fewer  than  240  different 
editions.  The  most  recent  of  these  is  the  French  trans- 
lation made  by  Meaux  Saint-Marc  and  published  by  him 
(2d  edition)  in  Paris  in  1880.  There  are  two  English 
versions — that  by  A.  Croke  (Oxford,  1830),  and  the  more 
recent  one  by  John  Ordronaux  (Philadelphia,  1871). 

Some  authorities  make  the  statement  that  the  poem  was 
written  originally  for  the  guidance  of  Robert,  the  son  of 
William  the  Conqueror;  but  Neuburger  says  that  the 
dedication  of  the  work  to  this  prince  is  lacking  in  many 
of  the  original  manuscript  copies  and  that  in  some  instances 
the  word  "Francorum"  is  to  be  found  in  the  place  of 


MEDICAL  INSTRUCTION  AT  SALERNO      251 

''Anglorum";  for  which  reason  he  believes  that  the 
introduction  of  a  dedication  was  made  long  after  the  poem 
had  been  written.  It  will  probably  appear  strange  to  most 
readers  that  the  author  of  the  ^^ Regimen  Sanitatis^^  (or 
^^Flos  Medicinae/'  as  it  was  sometimes  called)  should  have 
written  his  text  in  the  form  of  verse  rather  than  in  that 
of  prose.  He  himself  states  briefly,  at  the  end  of  the  poem,' 
some  of  the  reasons  why  he  preferred  to  adopt  this  course. 
Ehythm,  he  maintains,  makes  it  easy  to  say  a  great  deal  in 
a  few  words ;  besides  which,  it  facilitates  by  its  novelty  the 
memorizing  of  new  facts,  and  also  enables  one  quickly  to 
recall  to  mind  those  which  have  been  learned  at  some 
previous  time.  His  judgment  seems  to  have  been  entirely 
correct,  for  the  book  proved  to  be  immensely  popular,  and 
retained  its  popularity  throughout  an  extraordinarily  long 
period  of  time.  Furthermore,  as  already  stated,  it  accom- 
plished a  great  deal  toward  enhancing  the  reputation  of 
the  Salerno  School  of  Medicine.  When  we  consider  how 
difficult  it  must  have  been  in  those  days  for  students  of 
medicine  to  memorize  facts  which  were  stored  in  books  that 
were  very  costly  and  oftentimes  not  obtainable  at  any 
price,  we  cease  to  wonder  at  the  great  popularity  of  this 
miniature  cyclopaedia  in  leonine  verse.*  Here  were  to  be 
found,  at  one-fourth  or  one-tenth  the  price  of  any  similar 
book  written  in  prose,  all  the  essentials  (anatomy,  physi- 
ology, pathology,  etc.)  required  by  the  candidate  for 
medical  honors;  and  if,  perchance,  he  possessed  a  good 
memory,  he  might,  without  a  very  great  mental  effort, 
transfer  the  entire  poem  to  his  own  private  storehouse 
of  facts. 

A  few  extracts  from  this  remarkable  piece  of  medical 
literature  are  given  below,  in  the  belief  that  many  of  our 
readers  will  find  them  of  interest. 

3  Under  the  heading  ' '  Epilogus ' '  on  pages  268  and  269  of  Meaux  Saint- 
Marc 's  version. 

*  Examples  of  leonine  versification :  ' '  Contra  vim  mortis,  nulla  est  herba  in 
Jiortis" ;  (p.  155  of  Saint-Marc's  version)  and  (from  Shelley's  Cloud)  "1  am 
the  daughter  of  the  earth  and  water." 


252 


GROWTH  OF  MEDICINE 


OEIGINAL  TEXT 
Si  vis  incolumen,  si  vis  te  vivere 

sanum, 
Curas  toUe  graves,  irasei  crede 

profanum, 
Parce  mero,  coenato  parum ;  non 

sit  tibi  vanum 
Surgere   post    epulas;    sommini 

fuge  meridianum ; 
Ne  mictum  retine,  ne  comprime 

fortiter  anum. 
Haec  bene  si  serves,  tu  longo 

tempore  vives. 


Conditipnes  Necessariae  Medico. 
Clemens   accedat  medicus   cum 

vesta  polita ; 
Luceat     in     digitis     splendida 

gemma  suis. 
Si  fieri  valeat,  quadrupes  sibi 

sit  pretiosus; 
Ejus  et  omatus  splendidus  at- 

que  decens. 
Ornatu  nitido   conabere   carior 

esse, 
Splendidus      ornatus     plurima 

dona  dabit 
Viliter  induetus  munus  sibi  vile 

parabit. 
Nam  pauper  medicus  vilia  dona 

capit. 


DE.    JOHN    OEDEONAUX'S 

TEANSLATION 

If    thou    to    health,    and    vigor 

wouldst  attain. 
Shun  weighty  cares — all  anger 

deem  profane. 
From  heavy  suppers  and  much 

wine  abstain. 
Nor  trivial  count  it,  after  pom- 
pous fare. 
To  rise  from  table  and  to  take 

the  air. 
Shun  idle,  noonday  slumber,  nor 

delay 
The  urgent  calls  of  Nature  to 

obey. 

Demeanor  Necessary  For  the 

Physician. 
Let  doctors  call  in  clothing  fine 

arrayed, 
With  sparkling  jewels  on  their 

hands  displayed; 
And,  if  their  means  allow,  let 

there  be  had, 
To  ride,   a  showy,   rich-attired 

pad. 
For  when  well  dressed  and  look- 
ing over-nice, 
You  may  presume  to  charge  a 

higher  price. 
Since  patients  always  pay  those 

doctors  best. 
Who  make  their  calls  in  finest 

clothing  dressed, 
While  such  as  go  about  in  simple 

frieze. 
Must  put  up  with  the  meanest 

grade  of  fees ; 
For    thus    it    is,    poor    doctors 

everywhere 
Get   but   the   smallest   pittance 

for  their  share. 


MEDICAL  INSTRUCTION  AT  SALERNO      253 

At  Salerno  the  anatomical  demonstration  made,  appar- 
ently only  once  a  year,  for  the  benefit  of  the  students, 
consisted  in  exposing  to  view  the  abdominal  viscera  of  the 
pig  and  commenting  upon  the  features  which  distinguish 
them  from  the  same  organs  in  the  human  body.  In  the 
^^ Regimen  Sanitatis"  only  eight  lines  of  text  are  devoted 
to  anatomy. 

In  section  IV.,  which  relates  to  physiology,  the  text  is 
more  instructive  and  entertaining,  but  still — as  compared 
with  the  splendid  work  accomplished  by  Galen — extremely 
incomplete  and  superficial. 

In  the  early  part  of  the  twelfth  century,  Nicolaus 
Praepositus^  composed,  at  the  request  of  his  colleagues  in 
the  school  of  Salerno,  an  **Antidotarium" — that  is,  a 
collection  of  formulae  for  combining  together,  in  a  single 
pharmaceutical  preparation,  various  drugs,  both  those 
commonly  employed  in  that  part  of  Europe  and  others 
which  were  then  known  only  to  the  Arabian  physicians. 
This  book  of  formulae,  containing  as  it  did  descriptions 
of  the  effects  which  might  be  expected  from  the  different 
preparations,  and  furnishing  instructions  with  regard  to 
the  proper  mode  of  employing  them,  served  its  purpose 
admirably,  not  only  in  Salerno  but  throughout  Europe,  at 
least  during  the  Middle  Ages.  All  the  pharmacopoeias  of 
a  later  date  were  based  upon  his  ''Antidotarium,"  and 
indirectly  upon  the  still  earlier  celebrated  treatises  written 
by  Matthew  Platearius  and  bearing  the  titles  '^Glossae^^ 
and  '^ Circa  instans^^  (also  that  of  '^De  simplici  medicina^^). 
The  most  remarkable  item,  however,  which  is  to  be  found 
in  the  Antidotarium  is  that  in  which  mention  is  made  of 
the  use  of  soporific  sponges  {^'spongia  soporifera'^),  for 
anaesthetizing  purposes  by  means  of  inhalations,  in  certain 
surgical  procedures.  (Neuburger.)  They  were  made  by 
impregnating  the  sponges  thoroughly  with  the  juices  of 
narcotic  plants  (opium,  hyoscyamus,  mandragora,  lactuca, 
cicuta,  etc.),  drying  them,  and  putting  them  aside  until  they 
were  actually  needed.    Then  the  sponge  was  saturated  for 

5  The  term  ' '  praepositus ' '  means  the  president  or  the  dean  of  the  school 
with  which  the  person  named  is  connected. 


254  GROWTH  OF  MEDICINE 

about  an  hour  with  hot  water  or  steamed,  after  which  it 
was  applied  over  the  patient's  nostrils  and  held  there  until 
the  inhalation  of  the  fumes  had  induced  sleep. 

Another  Salernian  treatise  worth  mentioning  is  that 
written  by  Peter  Musandinus,  under  the  title  *'0n  Foods 
and  Beverages  suitable  for  Persons  affected  with  a  Fever. ' ' 
This  writer,  who  was  one  of  the  teachers  at  the  school  of 
Salerno  about  the  middle  of  the  twelfth  century,  says  that 
great  attention  was  paid  in  his  time  to  the  preparation  of 
foods  in  such  a  manner  as  to  tempt  the  appetite  of  people 
who  were  ill.  He  speaks  of  a  meat  extract  which  is  pre- 
pared from  the  flesh  of  the  chicken,  and  also  recommends 
that  a  soup  made  by  boiling  a  fowl  in  rose  water  be  given 
to  patients  who  are  affected  with  diarrhoea.  He  even  goes 
so  far  as  to  lay  stress  upon  the  importance  of  serving  food 
to  a  sick  person  in  dishes  which  are  pleasing  to  the  eye. 
Apropos  of  the  subject  of  foods  that  are  easily  digestible 
and  therefore  suitable  for  invalids  I  may  mention  how 
Meaux  Saint-Marc  translates  or  interprets  the  line  in  the 
''Regimen  Sanitatis  Salernitanum"  which  reads  0  fluvialis 
anas,  quanta  dulcedine  manas!  His  version  may  be  ren- 
dered into  English  thus : 

* '  Oh  wood-duck,  how  gently  doth  thy  soft  flesh  glide  over 
the  internal  surface  of  the  stomach!" 

Toward  the  end  of  the  twelfth  century  (1180  A.  D.)  there 
was  published  at  Salerno  a  work  on  surgery — the  oldest 
treatise  on  this  subject  that  is  known  to  have  been  written 
in  Italy  during  the  Middle  Ages.  It  is  now  called  ' '  Roger 's 
Practice  of  Surgery,"  but  originally  it  was  spoken  of  (in 
accordance  with  a  custom  quite  common  in  those  days)  as 
^^Post  mundi  fahricam,"  which  are  the  first  three  words 
of  the  text.  This  book  is  of  a  very  practical  character  and 
is  written  in  a  simple,  straightforward  style.  While  it 
contains  the  usual  amount  of  traditional  knowledge  about 
surgical  matters,  it  gives  at  the  same  time  the  results  of 
the  personal  experience  of  Roger,  of  his  teachers,  and  of 
his  associates.  As  published  in  the  ^^Collectio  Salernitana^* 
the  work  represents,  not  the  treatise  as  it  was  originally 
written,  but  a  revision  made  by  Rolando  of  Parma.    It  is 


MEDICAL  INSTRUCTION  AT  SALERNO      255 

divided  into  four  parts  or  books,  the  topics  treated  in  which 
comprise  most  of  those  usually  discussed  in  works  on 
surgery.  Under  the  heading  ** Wounds  of  the  Intestine," 
in  Book  III.,  there  occurs  this  most  remarkable  piece  of 
advice,  viz.,  *'to  insert  into  the  intestinal  canal  a  small 
tubular  piece  of  elder  and  then  to  stitch  the  raw  edges  of 
the  bowel  together  over  it." 

Another  treatise  on  surgery,  entitled  ^^Chirurgia 
Jamati/'  was  published  at  Salerno  before  the  end  of  the 
twelfth  century.  Its  authorship  is  attributed  to  Jamerius, 
and  in  many  respects  it  resembles  closely  the  treatise  of 
Roger. 

The  ^'Regimen  Sanitatis^^  was  not,  it  appears,  the  only 
treatise  on  medicine  which  was  published  at  that  period 
in  the  form  of  a  poem.  Gilles  de  Corbeil  (Petrus  Aegidius 
Corboliensis),  who  had  received  his  professional  training 
at  the  school  of  Salerno  and  was  afterward  appointed  the 
personal  physician  of  King  Philip  Augustus  in  Paris 
(1180-1223  A.  D.),  wrote  versified  treatises  on  these  two 
groups  of  topics — *'The  pulse,  the  urine,  and  the  beneficial 
characteristics  of  composite  remedies,"  and  ''The  signs 
and  symptoms  of  the  different  maladies."  Both  of  these 
treatises  were  received  everywhere  throughout  Europe 
with  great  favor  and  they  maintained  their  popularity  for 
a  period  of  over  four  centuries.  A  French  translation  (by 
C.  Vieillard)  of  the  treatise  on  urology  was  published  in 
Paris  in  1903.  An  edition  of  the  '^De  signis  et  symptoma- 
tihus  aegritudinum^^  was  printed  in  Leipzig  in  1907.  The 
following  five  lines  are  quoted  by  Neuburger;  and  they 
certainly  display  the  remarkable  gift  possessed  by  Aegidius 
for  condensing  a  large  amount  of  information  into  a  very 
small  space: — 

DE  CONDITIONIBUS  URINAE 

Quale,  quid,  aut  quid  in  hoc,  quantum,  quotiens,  uhi,  quando, 

Aetas,  natura,  sexus,  labor,  ira,  diacta, 

Cura,  fames,  motus,  lavacrum,  cibus,  unctio,  potus, 

Debent  artifici  certa  ratione  notari. 

Si  eupit  urinae  judex  consultus  haberi. 


256  GROWTH  OF  MEDICINE 

To  translate  this  into  easily  comprehensible  English 
prose  would  certainly  require  the  employment  of  at  least 
five  times  as  many  words. 

Another  physician  who  received  a  part  of  his  training 
at  Salerno  and  who  is  mentioned  by  Neuburger  as  *'The 
greatest  eye  surgeon  of  the  Middle  Ages,"  is  Benevenutus 
Grapheus  (twelfth  century),  a  native  of  Jerusalem,  and 
probably  of  Jewish  parentage.  He  wrote  a  practical 
treatise  {^'Practica  oculorum^')  which  had  a  wide  circula- 
tion, and  which  has  been  translated  into  Provengal,  French 
and  English. 

Toward  the  end  of  the  thirteenth  century  the  famous  Med- 
ical School  of  Salerno  began  to  show  signs  of  decadence. 
Various  circumstances  were  responsible  for  this  change. 
In  the  first  place,  its  career  of  great  usefulness  had  already 
covered  a  period  of  about  seven  hundred  years,  and — 
according  to  the  law  affecting  all  things  human — its  time 
of  decrepitude  was  already  more  than  due.  Then,  in  the 
next  place,  vigorous  rivals  were  beginning  to  appear  in 
different  parts  of  Europe, — at  Bologna,  at  Montpellier  and 
at  Paris, — and  these  new  schools  must  have  attracted  large 
numbers  of  students  who  otherwise  would  have  frequented 
the  University  of  Salerno  for  the  educational  facilities 
which  they  required.  Commercialism — ^if  such  a  term  may 
be  employed  to  characterize  the  action  of  those  who  were 
not  willing  to  undergo  the  entire  course  of  training 
required  for  obtaining  the  full  privileges  belonging  to  a 
physician — may  perhaps  also  be  named  as  one  of  the 
influences  which  contributed  to  the  slow  breaking  up  of 
the  school.  That  this  force  had  already  begun  to  exert 
some  effect  upon  the  management  of  the  institution  may 
be  inferred  from  the  fact  that  in  1140  A.  D.,  Roger,  King 
of  Sicily  and  Naples,  promulgated  the  law  that  nobody 
would  be  permitted  to  practice  medicine  in  his  kingdom 
until  he  should  have  satisfied  the  royal  authorities  that  he 
was  properly  qualified  to  undertake  such  practice.  The 
establishment  of  such  a  law  surely  indicated  that  the 
number  of  those  who  were  incompetent  to  assume  the 
responsibilities  of  a  practitioner  of  medicine  was  alarm- 


MEDICAL  INSTRUCTION  AT  SALERNO      257 

ingly  on  the  increase;  and,  after  it  had  gone  into  effect, 
many  must  have  been  deterred  from  choosing  a  medical 
career,  and  perhaps  others  have  been  diverted  to  schools 
which  were  located  in  countries  where  the  laws  were  more 
lax.  In  1240  A.  D.  the  Eoman  Emperor  Frederic  II.,  who 
was  also  King  of  Sicily,  made  it  a  law  that  the  course  of 
medical  studies  at  Salerno  should  cover  a  period  of  five 
years.  All  these  factors  taken  together  would  seem  to  have 
been  sufficient  slowly  to  diminish  the  popularity  of  this 
celebrated  school.  But  to  these  there  were  added,  in  the 
latter  half  of  the  thirteenth  century, — if  we  may  believe 
Puschmann, — two  new  factors,  which  exerted  a  powerful 
influence  in  destroying  all  hope  of  further  regeneration, 
viz.,  the  establishment  of  a  university  at  Naples,  in  1258 
A.  D.,  by  Manfred,  King  of  Sicily,  and  the  narrow  and 
illiberal  spirit  in  which  the  Church,  by  this  time  in  almost 
full  control  of  the  education  at  Salerno,  managed  the 
medical  school. 

During  the  following  four  centuries  the  University  of 
Salerno — for  during  the  thirteenth  century  it  became  a 
university  in  fact,  if  not  in  name — retrograded  steadily, 
until  finally  the  French  Government,  on  November  29,  1811, 
officially  put  an  end  to  its  existence.  The  traveler  who 
to-day  visits  Salerno,  in  the  hope  of  seeing  some  remains 
of  the  oldest  medical  school  in  Europe,  will  find  there  only 
a  collection  of  squalid  buildings  which  serve  as  dwellings 
for  the  poorer  classes,  a  dirty  and  uncomfortable  inn,  and 
shops  of  nearly  the  same  dimensions  as  those  which  once 
lined  the  narrow  streets  of  Pompeii.  As  he  gazes,  how- 
ever, at  the  superb  view  presented  by  the  Gulf  of  Salerno 
he  may  readily,  by  an  effort  of  the  imagination,  reconstruct 
the  picture  of  the  famous  *  *  Hippocratic  City"  as  it  was 
when  William  the  Conqueror  and  other  distinguished 
persons  visited  it  nearly  a  thousand  years  ago. 

Neuburger,  in  his  review  of  the  career  of  the  Salerno 
Medical  School,  sums  up  its  contributions  to  the  science 
of  medicine  in  about  these  terms:  Those  who  taught  at 
Salerno  were  the  first  physicians  in  the  Christian  part  of 
Western  Europe  who  procured  for  medicine  a  home  in 


258  GROWTH  OF  MEDICINE 

which  scientific  considerations  alone  prevailed,  where  the 
Church  exercised  no  control  whatever,  and  where  all  the 
different  branches  of  the  science  were  favored  to  an  equal 
degree.  They  devoted  their  best  energies,  by  oral  teaching 
and  by  their  writings,  to  the  single  object  of  communicating 
practical  knowledge  of  the  healing  art  to  all  who  desired 
to  obtain  it;  and,  by  the  admirable  example  of  their  own 
lives,  they  furnished  a  high  standard  for  the  guidance 
of  those  who  wished  to  reflect  honor  upon  the  name  of 
physician. 


^ 


CHAPTER  XXII 

EARLY  EVIDENCES  OF  THE  INFLUENCE  OF  THE 
RENAISSANCE  UPON  THE  PROGRESS  OF  MEDI- 
CINE IN  WESTERN  EUROPE 

In  previous  chapters  we  have  seen  how  the  Arabs, 
inspired  with  an  extraordinary  zeal  for  acquiring  knowl- 
edge of  the  different  sciences,  devoted  time  and  money 
freely,  throughout  a  period  of  several  centuries,  to  the 
accomplishment  of  this  purpose.  They  were  fired  with 
ambition  to  become  a  great  nation,  and  their  studies  of  the 
world's  history  taught  them  that  the  ancient  Greeks  had 
accumulated  in  their  literature  vast  stores  of  the  very 
knowledge  which  they  were  so  anxious  to  acquire.  Accord- 
ingly all  their  energies  were  directed  toward  converting 
these  stores  from  the  Greek  into  their  own  language,  the 
Arabic.  This  widespread  eagerness  of  the  nation,  at  a  given 
period  of  its  history,  to  improve  itself  intellectually  is 
spoken  of  as  the  Arabic  Renaissance,  and,  at  the  time  which 
I  am  now  about  to  consider,  the  movement  had  practically 
come  to  a  standstill.  A  short  time,  however,  before  this 
occurred,  the  physicians  of  Italy  and  of  the  more  northerly 
countries  of  Western  Europe  began  to  show  a  similar 
desire  to  add  to  their  medical  literature;  and  their  first 
step,  like  that  of  the  Arabs  four  or  five  centuries  earlier, 
was  directed  to  the  work  of  translating  Arabic  medical 
treatises  into  debased  Latin,  which  was  the  language 
commonly  employed  by  the  learned  during  the  Middle 
Ages.  The  knowledge  which  they  desired  to  acquire  could 
not  at  that  time  be  obtained  in  any  other  way,  for  nobody 
was  acquainted  with  the  Greek  language,  and,  besides, 
Greek  originals  had  not  yet  been  brought  into  Western 


260  GROWTH  OF  MEDICINE 

Europe.  These  first  evidences  of  the  Renaissance  in  that 
part  of  the  world  were  not  confined  to  physicians;  they 
were  to  be  found  in  every  walk  of  life.  The  development 
of  the  movement  reminds  one  of  what  takes  place  near  the 
sea  coast,  where  a  period  of  heat  and  calm  is  suddenly 
broken  by  the  appearance  of  a  few  gentle  puffs  of  wind, 
which  are  quickly  succeeded  by  the  full  force  of  a  steady 
and  refreshing  sea-breeze.  In  like  manner  feeble  indica- 
tions of  the  coming  movement  appeared  in  Italy,  France, 
Germany  and  even  England,  and  these  were  soon  followed 
by  unmistakable  evidences  that  a  genuine  Renaissance  of 
widespread  proportions  had  begun.  It  was  as  if  a  great 
awakening  had  taken  place  among  the  nations  which  had 
for  centuries  lain  dormant;  an  awakening  which  was 
followed  by  a  desire  to  lay  aside  the  trivial  pursuits  in 
which  they  had  so  far  been  engaged,  and  to  attain  those 
results  which  were,  later  on,  to  excite  the  wonder  and 
admiration  of  the  world.  Such  were,  for  example,  the 
development  of  the  art  of  printing  ^4th  movable  types; 
the  discovery  of  America;  the  production  of  such  clever 
painters,  sculptors,  engravers,  workers  in  metal,  etc.,  as 
Michael  Angelo,  Raphael,  Albrecht  Diirer,  Benvenuto 
Cellini,  Rembrandt,  and  literally  scores  of  others  of  nearly 
equal  merit;  the  development  of  a  Shakespeare,  a  Milton 
and  a  Dante  in  the  field  of  literature ;  the  production  of  a 
Luther,  a  man  who  had  the  courage  to  protest  against  evil 
practices  which  had  crept  into  the  Christian  church.  And 
medicine,  as  I  have  already  stated,  felt  the  influence  of 
the  approaching  Renaissance,  and  responded  to  it  by 
eJEforts  which  had  for  their  object  the  acquisition  of  such 
knowledge  as  might  be  furnished  by  translations  from 
Arabic  treatises.  Constantinus,  the  African,  of  whom 
mention  has  been  made  on  a  previous  page,  seems  to  have 
been  the  first  person  (toward  the  end  of  the  eleventh  cen- 
tury) who  did  any  work  of  this  kind;  but  his  associates  in 
Salerno  do  not  appear  to  have  valued  these  translations 
very  highly,  or  else,  perhaps,  they  were  not  yet  prepared 
to  give  serious  consideration  to  works  which  were  new  to 
them.     In  the  twelfth  century,  as  will  now  be  seen,  the 


INFLUENCE  OF  THE  RENAISSANCE        261 

attitude  of  the  physicians  of  Western  Europe  underwent 
a  change. 

The  city  of  Toledo,  in  Spain,  was  richly  stocked  with 
the  manuscript  treasures  of  Arabic  literature  at  the  time 
(1085  A.  D.)  when  it  fell  into  the  hands  of  the  Christians. 
One  of  the  earliest  scholars  to  engage  in  the  work  of  trans- 
lating these  treasures  into  Latin  was  Gerard  of  Cremona, 
in  Lombardy,  who  lived  during  the  twelfth  century  (1114- 
1187  A.  D.).  He  spent  most  of  his  lifetime  in  Toledo, 
*  learning  and  teaching,  reading  and  translating."  (Neu- 
burger.)  Among  the  medical  works  which  he  translated 
from  the  Arabic  the  most  important  are  the  following: 
Several  of  the  writings  of  Hippocrates  and  Galen;  the 
Breviarium  of  Serapion ;  several  of  the  writings  of  Rhazes 
and  of  Isaac  Judaeus ;  the  treatise  on  surgery  by  Abulcasis ; 
the  Canon  of  Avicenna,  etc.  This  stimulated  many  others 
to  follow  in  the  footsteps  of  Gerard  of  Cremona ;  and  thus, 
during  the  thirteenth  century,  a  number  of  works  of 
importance  were  translated  in  addition  to  those  already 
mentioned.  Such,  for  example,  were  the  **Colliget"  of 
Averroes  by  Bonacosa,  a  Jew  (1255)  of  Padua;  the 
^'Te'issir"  of  Avenzoar,  and  the  ''Dietetics"  of  Maimonides 
by  John  of  Capua,  a  Jewish  convert  to  Christianity  (1262- 
1278) ;  the  ''Z>e  veribus  cordis"  of  Avicenna  by  Arnaldus 
of  Villanova  (about  1282);  the  treatise  '^De  simplicihus" 
of  Serapion  the  Younger,  and  the  ^^ Liber  servitoris^^  of 
Abulcasis,  by  Simon  Januensis;  and  many  others.  This 
wave  of  keen  interest  in  the  writings  of  Arabic  physicians 
and  in  the  Arabic  versions  of  Greek  medical  authors  soon 
reached  Languedoc  in  France,  and  then  passed  over  from 
there  into  Italy.  For  a  long  time  the  Salerno  physicians 
resisted  its  influence,  but  they  finally  yielded  to  it,  as  the 
leaders  in  the  schools  of  Bologna,  Naples,  Montpellier  and 
Paris  had  already  done.  It  was  at  Palermo,  in  Sicily, 
however,  that  the  movement  received  its  greatest  impetus. 
Frederick  II.,  at  that  time  King  of  Sicily,  and  a  ruler  who 
was  most  tolerant  in  religious  matters,  had  at  his  Court 
an  entire  staff  of  Arabic  physicians,  philosophers,  astrolo- 
gers and  poets;  and,  in  addition,  he  kept  a  number  of 


262  GROWTH  OF  MEDICINE 

learned  Christians  and  Jews  constantly  busy  translating 
Arabic  works  into  Latin.  The  most  widely  known  member 
of  the  latter  group  was  Michael  Scotus  (or  Scottus),  who 
at  one  time  had  been  a  teacher  in  the  Medical  School  of 
Salerno.  Among  the  books  which  he  translated  while  he 
was  at  Palermo  there  were  several  of  Aristotle 's  treatises, 
more  particularly  those  which  dealt  with  psychological 
topics  and  with  natural  history.  Frederick  not  only  did 
everything  in  his  power  to  promote  the  work  of  trans- 
lating, he  also  took  pains  to  distribute  copies  of  the  Latin 
versions,  when  completed,  among  the  universities  of 
Western  Europe.  His  son,  Manfred,  who  succeeded  him 
on  the  throne,  seems  to  have  been  almost  as  much  interested 
in  the  work  as  his  father  had  been.  It  was  from  him,  for 
example,  that  the  University  of  Paris  received  a  set  of  the 
Aristotle  volumes  in  Latin.  When  Charles  I.,  King  of 
Naples  (1265-1285  A.  D.),  conquered  Sicily  he  manifested 
considerable  interest  in  continuing  the  work  of  his  prede- 
cessors, particularly  as  regards  treatises  relating  to  medi- 
cine. Among  the  translators  whom  he  employed  for  this 
work  was  Farragut  (in  Arabic,  Faradsch  ben  Salem),  from 
Girgenti,  a  small  town  on  the  south  coast  of  Sicily,  about 
sixty  miles  from  Palermo.  In  addition  to  several  treatises 
of  minor  importance  he  translated  into  Latin  the  colossal 
work  of  Rhazes — the  ' '  Continens. "  Charles  I.  kept  at  his 
Court  not  only  expert  translators,  but  also  skilled  illumi- 
nators ;  and  it  was  by  them  that  the  celebrated  manuscript 
copy  of  this  work  which  is  to-day  in  the  Bibliotheque 
Nationale  at  Paris,  was  illustrated  with  miniatures,  three 
of  which  are  portraits  of  Farragut.  This  particular  copy 
of  the  *'Continens"  was  completed  in  1282  A.  D.  Not  a 
few  of  the  translations  made  during  this  period,  it  should 
be  stated,  are  now  very  difficult  to  understand.  In  the  first, 
place,  the  Latin  in  which  they  are  written  is  of  the  barbaric 
type  (neo-Latin),  something  quite  different  from  that 
employed  by  Cicero,  Tacitus  and  other  Roman  authors  of 
the  classical  period ;  and,  in  the  next,  it  is  not  infrequently 
evident  that  the  translator  himself  did  not  clearly  appre- 
hend the  meaning  of  the  original  Arabic  text.    Despite  all 


INFLUENCE  OF  THE  RENAISSANCE        263 

these  drawbacks,  however,  the  placing  of  Latin  versions 
of  Arabic  writings  within  the  reach  of  European  physicians 
accomplished  much  good.  Even  the  imperfections  to  which 
reference  has  just  been  made  probably  served  to  increase 
the  eagerness  of  these  men  to  gain  access  to  the  real  sources 
of  Arabic  learning — ^viz.,  the  writings  in  the  original  Greek. 
To  anticipate  a  little,  I  may  say  here  that  this  object  was 
not  attained  until  after  the  lapse  of  about  two  more  cen- 
turies— that  is,  not  until  the  scholars  of  Western  Europe 
had  learned  to  read  the  Greek,  and  had  also  brought  out 
from  their  hiding  places  in  churches  and  monasteries  of 
the  East  the  needed  originals.  At  that  period  of  the  world's 
history  centuries  corresponded  to  decades  as  modern 
events  are  recorded. 

One  may  gain  some  idea  of  the  extent  to  which  these 
Latin  translations  of  Arabic  original  treatises  and  of 
Arabic  versions  of  Greek  medical  works  influenced  the 
physicians  of  Western  Europe,  by  consulting  one  of  the 
important  medical  treatises  of  the  fourteenth  century — 
that,  for  example,  of  Guy  de  Chauliac  (written  1363  A.  D.). 
Edouard  Nicaise,  the  accomplished  editor  of  this  and 
several  other  mediaeval  medical  treatises,  has  printed  in 
his  preface  Joubert's  table  showing  just  how  often  Guy 
quotes  each  one  of  about  four  score  earlier  authors,  and 
from  this  analysis  it  appears  that  Abulcasis  was  quoted 
175  times,  Aristotle  62  times,  Avicenna  661  times,  Galen 
890  times,  Haly  Abbas  149  times,  Mesne  61  times,  Hip- 
pocrates 120  times,  and  Ehazes  161  times ;  or,  to  state  the 
facts  somewhat  differently,  the  quotations  from  treatises 
introduced  into  Western  Europe  by  the  Arabs  represent, 
in  the  present  instance,  70  per  cent  of  all  the  quotations 
(2279  of  a  total  of  3243)  made  by  this  author.  Another 
equally  strong  piece  of  evidence  is  that  afforded  by  Vincent 
de  Beauvais'  encyclopaedia, — a  work  published  in  Paris 
toward  the  middle  of  the  thirteenth  century, — in  which  the 
parts  relating  to  medicine  appear  to  have  been  taken  very 
largely  from  treatises  written  by  Arabic  authors.  (See 
statement  on  page  270. )  There  can  therefore  be  no  reason- 
able doubt  that  the  Arabs  played  a  most  important  part 


264  GROWTH  OF  MEDICINE 

in  the  renaissance  of  medical  learning  which  began  a  cen- 
tury or  two  earlier,  which  already  in  the  thirteenth  century 
had  made  great  progress,  and  which  very  soon — as  time  is 
reckoned  in  the  calendar  of  all  important  world  move- 
ments— was  to  culminate  in  that  still  greater  renaissance 
called  '* modern  medicine." 

During  the  later  portion  of  the  Middle  Ages  (thirteenth 
and  fourteenth  centuries)  there  were  four  universities 
which  possessed  medical  schools  of  considerable  impor- 
tance— viz.,  those  of  Bologna  and  Padua  in  Italy,  and  those 
of  Montpellier  and  Paris  in  France.  All  of  these  seats  of 
learning,  like  the  famous  school  at  Salerno,  developed  so 
gradually  and  from  such  modest  beginnings  that  it  is 
scarcely  possible  to  assign  to  any  of  them  a  date  of  origin. 
Medicine  was  taught  at  several  other  places — as,  for 
instance,  at  Oxford,  England;  at  Naples,  Vicenza,  Siena, 
Rome,  Florence,  Ferrara,  Pisa  and  Pavia,  in  Italy;  at 
Salamanca  and  Lerida,  in  Spain;  at  Prague,  in  Bohemia; 
at  Cologne,  in  Germany;  at  Vienna,  in  Austria,  etc.  But 
the  part  which  these  smaller  schools  played  in  the  work 
of  advancing  our  knowledge  of  medicine  was  certainly  of 
far  less  importance  than  that  which  fell  to  the  lot  of  the 
four  institutions  just  mentioned. 

The  University  of  Montpellier,  if  not  the  oldest  of  the 
four  schools  mentioned,  was  apparently  the  first  to  attain 
some  degree  of  celebrity.  It  is  known,  for  example,  that 
the  Archbishop  of  Lyons,  who  was  suffering  at  the  time 
from  some  malady  which  the  physicians  of  that  city  were 
not  able  to  cure,  visited  Montpellier  1153  A.  D.  in  the  belief 
that  he  might  there  obtain  the  desired  relief.  John  of 
Salisbury,  who  lived  during  the  latter  half  of  the  twelfth 
century  and  who  was  considered  one  of  the  greatest 
scholars  of  his  time,  declared  that  those  who  wished  to 
acquire  a  satisfactory  knowledge  of  medicine,  found  that 
Salerno  and  Montpellier  were  the  only  places  where  the 
desired  instruction  might  be  obtained.  Gilles  de  Corbeil 
(mentioned  in  the  last  chapter).  Von  der  Aue,  and  other 
eminent  men  of  the  same  period  spoke  in  equally  favorable 
terms  of  the  merits  of  Montpellier.    The  celebrated  monk, 


INFLUENCE  OF  THE  RENAISSANCE        265 

Caesarius  of  Heisterbach,  calls  the  university  of  that  city 
''the  headquarters  of  medical  wisdom";  but  at  the  same 
time  he  expresses  regret  that  the  physicians  of  that  school 
not  only  do  not  believe  in  miraculous  cures,  but  speak  of 
them  ironically.  It  was  one  of  the  characteristics  of  the 
institution  that  the  teachers,  both  the  medical  and  the 
philosophical,  were,  at  a  very  early  period,  allowed  great 
freedom  of  thought  and  speech;  but,  as  time  went  on,  this 
liberty  became  very  much  curtailed.  During  the  thirteenth 
and  fourteenth  centuries  there  were,  it  appears,  many  Jews 
among  the  students  at  Montpellier,  not  merely  in  the 
department  of  medicine,  but  also  in  the  other  departments 
of  the  university. 

The  medical  schools  of  Salerno  and  Montpellier  seemed, 
at  this  early  period  (thirteenth  century),  to  possess  more 
individuality  than  did  the  similar  organizations  at  Bologna, 
Padua  and  Paris ;  for  limited  periods  of  time  each  of  them 
in  turn  enjoyed  a  certain  amount  of  fame  by  reason  of  the 
fact  that  some  teacher  or  writer  of  special  distinction 
happened  then  to  be  officially  connected  with  the  school. 
In  other  words,  it  was  the  fame  of  the  man  and  not  of  the 
school,  that  induced  students  to  visit  Bologna  or  Padua, 
or  Paris,  during  the  thirteenth  and  fourteenth  centuries. 
At  a  somewhat  later  period  (fifteenth  and  sixteenth  cen- 
turies) all  three  of  these  institutions  stood  out  prominently 
before  the  world  as  celebrated  medical  schools,  with  dis- 
tinctive characteristics.  To  be  invited  to  occupy  a  chair 
in  one  of  these  institutions  conferred  honorable  distinction 
upon  the  incumbent  selected,  and  when  I  reach  that  period, 
farther  on  in  this  history,  I  shall  describe  each  one  of  the 
more  important  schools  separately.  In  dealing  with  the 
earlier  epoch,  however,  it  seems  best  to  devote  our  attention 
more  particularly  to  individual  physicians  than  to  the 
schools  with  which  they  may  happen  to  be  connected. 

Among  the  physicians  belonging  to  the  latter  half  of  the 
thirteenth  and  the  first  quarter  of  the  fourteenth  century 
there  is  one  whose  proper  place  in  the  history  of  medicine 
is  by  no  means  easy  to  determine,  and  who  yet  played  a 
part    of   no    small   importance.      This    man    was    Pietro 


266  GROWTH  OF  MEDICINE 

d'Abano,  or  Petrus  Aponensis,  who  was  born  at  Abano,  a 
small  village  near  Padua,  1250  A.  D.  Very  little  is  known 
about  his  early  youth,  but  from  this  little  we  are  warranted 
in  drawing  the  conclusion  that  his  father,  a  notary,  must 
have  taken  great  pains  to  afford  him  every  possible  educa- 
tional advantage.  He  gave  his  son,  for  example,  the 
opportunity  of  studying  Greek  in  Constantinople, — a  thing 
of  rare  occurrence  in  those  early  days, — and  allowed  him 
to  remain  there  until  he  had  so  far  mastered  the  language 
that  he  was  able  to  translate  the  ^^Problemata"  of  Aris- 
totle from  the  original  text.  Then,  upon  his  return  home 
from  Constantinople,  he  was  sent  to  Paris  for  the  purpose 
of  perfecting  his  knowledge  of  philosophy,  mathematics 
and  medicine.  After  this  thorough  training  for  his  life 
work,  Pietro  d 'Abano  began  teaching  philosophy  in  Padua, 
and  almost  immediately  he  gained  such  success  that  people 
spoke  of  him  as  **the  great  Lombard."  However,  like 
most  of  the  men  of  that  time  who  became  conspicuous 
through  their  intellectual  attainments,  Pietro  d 'Abano  was 
soon  accused  by  the  Dominicans  of  being  a  heretic  and  of 
cultivating  the  magician's  art.  He  was  able  to  parry  this 
blow  by  making  a  journey  to  Rome  and  obtaining  from 
Pope  Boniface  VIII.  a  decree  of  absolution.  About  the 
same  time  he  began  writing  his  two  great  works — the 
^^Conciliator"  and  the  ''Commentaries  on  Aristotle's 
Problemata."  He  did  not  begin  to  teach  medicine  at  the 
University  of  Padua  until  1306,  when  he  was  already  fifty- 
six  years  of  age.  But  his  lectures,  reflecting  as  they  did 
the  depth  and  extent  of  his  learning  and  the  keenness  of 
his  powers  of  analysis,  were  a  source  of  great  astonishment 
to  his  contemporaries.  It  is  reported  by  Neuburger,  for 
example,  that  Gentile  da  Foligno,  one  of  the  most  distin- 
guished professors  in  the  Medical  School  of  Padua, 
happening  to  pass  near  the  auditorium  while  Pietro 
d 'Abano  was  delivering  his  lecture,  listened  for  a  short 
time  and  then  exclaimed:  ^^ Salve  o  santo  tempio'^ — ''Hail 
to  this  time  which  has  brought  forth  such  wonders ! ' '  With 
the  increase  of  Pietro 's  fame  came  also  a  decided  increase 
in  the  bitterness  of  the  persecution  carried  on  against  him 


INFLUENCE  OF  THE  RENAISSANCE        267 

by  his  ecclesiastical  foes,  largely  due  perhaps  to  his  open 
and  courageous  defense  of  the  Averroism  which  they  so 
much  hated.  There  is  very  little  doubt  that  he  would  have 
been  burned  at  the  stake  about  this  time  if  the  friendly 
disposition  of  the  Popes  and  the  mighty  influence  pos- 
sessed by  the  city  of  Padua  had  not  shielded  him  from  this 
danger.  In  1314  the  newly  founded  school  of  Treviso 
invited  Pietro  d'Abano  to  occupy  the  Chair  of  Medicine 
and  Physics,  and  he  accepted ;  but  he  was  taken  ill  and  died 
during  the  following  year.  Shortly  before  the  occurrence 
of  this  event  he  was  placed  on  trial  for  heresy  by  the 
Inquisition,  and  the  proceedings  were  continued  even  after 
his  death.  Indeed,  according  to  one  account  of  this  famous 
trial,  not  only  was  the  charge  sustained,  but  the  prescribed 
penalty  was  inflicted  either  upon  the  disinterred  corpse 
or  upon  an  effigy  of  the  condemned  man.  One  century  later, 
the  city  of  Padua  erected  a  permanent  memorial  in  Pietro 
d'Abano's  honor. 

The  principal  work  of  this  remarkable  physician — viz., 
the  ^^Conciliator  differ entiarium  philosophorum  et  prae- 
cipue  medicorum^^ — was  first  printed  at  Venice  in  1471. 
(It  is  said  to  be  one  of  the  earliest  printed  books  known.) 
It  was  a  most  popular  treatise,  as  is  shown  by  the  fact  that 
between  the  year  last  mentioned  and  1621  it  passed  through 
a  number  of  editions.  Of  the  other  treatises  which  he 
wrote — some  seven  or  eight  in  all — it  will  be  sufficient  to 
mention  here  that  one  alone  to  which  reference  has  already 
been  made  in  the  preceding  account,  viz.,  the  work  entitled 
'^Expositio  prohlematum  Aristotelis^^  (Mantua,  1475,  and 
Paris,  1520). 

At  this  early  period  in  the  history  of  the  Padua  Medical 
School  there  were  one  or  two  other  men  who  attained  a 
considerable  degree  of  celebrity  for  the  excellence  of  the 
work  which  they  did,  either  as  authors  or  as  class-room 
teachers.  A  brief  account  of  one  of  these,  Aegidius 
Corboliensis,  has  already  been  given  on  a  preceding  page, 
and  it  seems  only  fair  that  I  should  furnish  here  similar 
brief  accounts  of  some  of  the  others — Gentile  da  Foligno, 
Massilio  and  Galeazzo  de  St.  Sophia,  Giacomo  and  Giovanni 


268  GROWTH  OF  MEDICINE 

de'  Dondi,  and  Giacomo  della  Torre,  from  Forli,  all  of 
whom  contributed  greatly  to  the  steadily  increasing  fame 
of  the  Padua  School  of  Medicine ;  but,  under  the  conditions 
which  govern  the  preparation  of  this  brief  history,  I  must 
reluctantly  pass  over  these  names  in  silence. 


CHAPTER  XXIII 

FURTHER  PROGRESS  OF  MEDICINE  AND  SUR- 
GERY IN  WESTERN  EUROPE  DURING  THE 
THIRTEENTH,  FOURTEENTH  AND  A  PART  OF 
THE  FIFTEENTH  CENTURIES 

Among  the  men  who,  during  the  thirteenth  century, 
exerted  more  or  less  influence  upon  the  growth  of  medical 
knowledge  there  are  three  who  deserve  to  receive  some 
consideration  at  our  hands.  They  were  not  physicians, 
but  yet  some  of  their  writings  deal  with  topics  which  are 
closely  related  to  the  science  of  medicine.  They  are: 
Albert  von  BoUstadt,  a  German  who  is  generally  known 
as  Albertus  Magnus,  one  of  the  greatest  scholastic  philoso- 
phers of  the  Middle  Ages ;  Vincent  of  Beauvais  ( Vincentius 
Bellovacensis),  a  French  Dominican  monk,  who  was  reader 
to  Louis  IX.,  and  who  compiled  a  general  encyclopaedia 
which  brought  him  great  fame  at  that  period;  and  Roger 
Bacon,  an  Englishman  who,  by  reason  of  the  extraordinary 
extent  of  his  knowledge  and  his  remarkable  powers  of 
observation,  was  given  the  name  of  **  Doctor  mirabilis." 

Albertus  Magnus. — ^Albertus  Magnus  was  born  at 
Lauingen,  Swabia,  in  1193  A.  D.,  obtained  his  education 
in  Italy  (at  the  University  of  Padua,  during  the  latter  part 
of  his  stay),  joined  the  Order  of  the  Dominicans  on  arriving 
at  the  age  of  thirty,  and  afterwards,  throughout  his  long 
life,  devoted  himself  largely  to  teaching,  particularly  at 
Paris  and  Cologne.  He  was  a  prolific  writer  and  his  works, 
particularly  those  which  treat  of  topics  belonging  to  the 
domain  of  natural  history,  were  greatly  appreciated.  The 
eifect,  however,  which  they  produced  upon  a  certain  class 
of  readers  was  to  persuade  them  that  he  was   a  great 


270  GROWTH  OF  MEDICINE 

magician.  The  chief  distinction  of  his  writings  lies  in  the 
fact  that  they  contain  a  large  number  of  original  observa- 
tions which  he  made  during  the  course  of  his  journeys 
afoot  through  Germany  in  the  character  of  Provincial  of 
the  Dominican  Order.  This  habit  of  exercising  entire 
independence  in  the  use  of  his  reasoning  powers  was  some- 
thing quite  rare  in  those  days.  His  observations  were 
directed  chiefly  to  matters  belonging  to  the  domains  of 
zoology,  botany,  climatology,  mineralogy,  chemistry  and 
physics.  The  following  significant  advice,  says  Neuburger, 
is  attributed  to  him:  **As  regards  the  doctrines  which 
relate  to  questions  of  belief  and  of  morality,  it  is  the  part 
of  wisdom  to  attach  greater  authority  to  Saint  Augustine 
than  to  the  philosophers;  in  matters  belonging  to  the 
domain  of  medicine  put  your  chief  trust  in  Galen  and  in 
Hippocrates ;  in  natural  history,  however,  your  best  guide 
is  Aristotle."  Neuburger  adds  that,  throughout  the  writ- 
ings of  Albertus  Magnus,  there  appear  interesting  state- 
ments relating  to  anatomy,  physiology,  psychology,  and  the 
plants  and  minerals  which  may  be  used  for  remedial 
purposes. 

An  edition  of  the  writings  of  Albertus  Magnus  (21  folio 
volumes)  was  published  in  Lyons  by  Petrus  Jamy  in  1651. 
The  work  was  republished  in  Paris  in  1892  and  following 
years. 

Vincent  of  Beauvais. — Vincent  of  Beauvais,  France,  a 
Dominican  monk  who  lived  during  the  first  half  of  the  thir- 
teenth century  and  was  the  tutor  of  Louis  the  Ninth's 
children,  devoted  the  major  part  of  his  time  to  literary  work. 
He  wrote  many  theological  treatises  and  also  edited  a  large 
encyclopaedia  in  which  information  is  furnished  regarding 
everything  that  was  known  at  that  time.  Several  hundred 
authors  aided  him  in  compiling  this  work,  which  is  entitled 
^^  Speculum  Ma  jus/'  It  is  arranged  in  three  parts,  one  of 
which  {^^ Speculum  Naturale^')  consists  of  33  books  that  are 
divided  into  3740  chapters;  and  quite  a  number  of  the 
divisions  are  devoted  to  topics  relating  to  medicine.  The 
authors,  from  whose  writings  this  medical  information  has 
been  abstracted,  are  Hippocrates,  Aristotle,  Dioscorides, 


FURTHER  PROGRESS  OF  MEDICINE        271 

Haly  Abbas,  Rbazes,  Avicenna  and  several  others — not  to 
mention  the  Church  Fathers  and  other  encyclopaedic  writers 
connected  with  the  Church.  The  first  printed  edition  of  this 
great  work  appeared  toward  the  end  of  the  fifteenth  century 
(1473-1475  A.  D.) ;  the  last,  or  one  of  the  last,  in  1624.  Lack 
of  space  will  not  permit  me  to  give  any  details  concerning 
the  works  of  a  somewhat  similar  character  which  were 
prepared,  about  the  same  time,  by  the  English  Franciscan 
monk  Bartholomaeus  of  Glan villa  (1260) ;  by  the  Dominican, 
Thomas  of  Cantimpre  (1204-1280  A.  D.),  a  pupil  of  Albertus 
Magnus ;  and  by  others. 

Roger  Bacon. — Roger  Bacon  was  born  about  1210  A.  D. 
in  Ilchester,  Somersetshire,  England,  and  received  his  early 
training  at  Oxford.  When  he  was  thirty  years  of  age  he 
went  to  Paris  and,  after  devoting  himself  assiduously  for 
seven  years  to  the  study  of  various  branches  of  learning,  he 
received  the  Doctor's  degree  (1247).  The  wish  to  acquire 
a  thorough  knowledge  of  whatever  subject  he  undertook  to 
study  constituted  a  prominent  feature  of  his  character.  He 
was  fond  of  languages,  but  he  had  an  even  greater  love  for 
mathematics,  particularly  in  connection  with  astronomy,  and 
for  experimental  work  in  the  department  of  chemistry.  It 
is  said  that  he  expended  a  large  sum  of  money  (£2000)  upon 
these  chemical  investigations.  He  left  Paris  in  1250, 
returned  to  England,  and  not  long  afterward  joined  the 
Order  of  the  Franciscans.  Robert  Grossetete,  Bishop  of 
Lincoln,  and  the  Franciscan  monk  Adam  of  Marisco — two 
men  whom  Neuburger  describes  as  theologians  of  a  very 
liberal  type — exercised  a  strong  influence  upon  Bacon  at 
this  period  of  his  life.  They  confirmed  him  in  the  belief  that 
familiarity  with  the  learned  languages  was  an  acquisition 
greatly  to  be  prized,  and  at  the  same  time  they  gave  him 
every  encouragement  to  pursue  his  researches  in  mathe- 
matics and  in  natural  history.  For  a  certain  length  of  time 
he  was  an  instructor  at  Oxford,  but  his  views  with  regard 
to  ecclesiastic  and  moral  questions  and  the  discoveries  which 
he  made  in  physics  (especially  in  optics)  were  beyond  the 
comprehension  of  his  contemporaries,  who  did  not  hesitate 
to  pronounce  them  works  of  the  Devil  and  to  subject  Bacon 


272  GROWTH  OF  MEDICINE 

to  all  sorts  of  punishments  and  deprivations.  Fortunately 
for  him  and  for  the  cause  of  science  the  newly  elected  Pope, 
Clement  IV.  (1266),  came  to  his  rescue  in  those  dark  days 
and  granted  him-— under  the  promise  of  absolute  secrecy — 
permission  to  continue  his  researches  without  hindrance  and 
to  perfect  the  plans  which  he  had  in  mind  for  reforms  of 
different  kinds.  I  cannot  follow  this  pioneer  of  scientific 
research  work,  this  man  who  was  several  centuries  ahead 
of  the  time  in  which  he  lived,  through  all  the  vicissitudes  of 
his  interesting  and  extraordinarily  fruitful  life;  I  may 
simply  add  that  his  death  occurred  about  the  year  1294; 
that  he  left  behind  him  many  important  treatises,  only  a 
small  portion  of  which  have  thus  far  been  published,^  and 
that  from  these  alone  one  is  justified  in  classing  Roger 
Bacon  as  one  of  the  greatest  thinkers  whom  history  has 
recorded.  So  far  as  is  now  known,  he  wrote  very  little 
concerning  medicine,  and — strange  to  say — he  seems  to  have 
attached  considerable  importance  to  astrology;  indeed,  he 
went  so  far  as  to  blame  the  physicians  of  his  day  for  their 
ignorance  regarding  this  science, ' '  as  a  result  of  which  they 
neglect  the  best  part  of  medicine."  In  strange  contrast 
with  these  views,  which  to-day  we  characterize  as  foolish- 
ness, is  Bacon's  famous  dictum:  *' Experiment  is  a  firmer 
and  more  trustworthy  basis  of  knowledge  than  argument" — 
a  maxim  which  is  the  guiding  principle  of  modern  medicine. 

The  Medical  School  of  Bologi^a. — The  Medical  School 
of  Bologna  first  began  to  assume  a  certain  degree  of  promi- 
nence in  the  early  part  of  the  thirteenth  century,  under  the 
teaching  of  Thaddeus  Alderotti — also  frequently  called 
Thaddeus  of  Florence. 

Thaddeus  Alderotti. — Thaddeus  Alderotti,  who  was  born 
at  Florence,  Italy,  1223  A.  D.,  of  humble  parentage,  began 
the  study  of  philosophy  and  medicine  at  Bologna  only  after 
he  had  reached  manhood ;  but  he  was  such  an  earnest  student 
and  made  such  good  use  of  his  opportunities  that  in  1260 
he  was  chosen  to  serve  as  one  of  the  teachers  in  the  school. 
Throughout  a  period  of  many  years  he  filled  the  office  so 

iThe  Opus  majus,  ed.  J,  H.  Bridges,  Oxford,  1897  (2d  edition,  1900); 
opera  hactenus  inedita,  ed.  B.  Steele,  Fasc.  I.,  London. 


FURTHER  PROGRESS  OF  MEDICINE        273 

acceptably  that  his  colleagues  bestowed  upon  him  the  name 
of  ''Master  of  Physicians."  Before  this  time  arrived, 
however,  his  lack  of  funds  was  sorely  felt,  for  he  was 
obliged,  in  order  to  support  himself,  to  offer  consecrated 
wax  candles  for  sale  at  the  entrance  of  the  church.  He  is 
reported  to  have  been  not  merely  a  most  learned  physician, 
but  also  a  very  successful  practitioner.  He  was  called  into 
consultation  from  all  parts  of  the  country,  so  highly  was 
his  opinion  valued  by  other  physicians ;  and  thus  in  due  time 
he  accumulated  a  large  fortune.  His  charges  were  by  no 
means  small.  It  is  related,  for  example,  that  Pope  Hono- 
rius  IV.  sent  for  him  to  come  to  Rome,  and,  after  the  treat- 
ment was  completed,  paid  him  a  fee  of  10,000  gold  pieces^ — 
but  not  until  after  he  had  expressed  surprise  that  Thaddeus 
should  have  charged  as  much  as  100  gold  pieces  per  day  for 
his  services.  To  this  demurrer  on  the  part  of  the  Pope, 
Thaddeus  replied  that  the  petty  princes  and  even  the  simple 
nobles  made  no  objection  to  paying  him  50  or  more  gold 
pieces  per  day.  It  is  scarcely  necessary  to  add  that  the 
Holy  Father  did  not  wish  to  be  outdone  by  his  inferiors. 

Alderotti  died  1303  A.  D. 

Among  the  writings  of  Thaddeus  Alderotti  which  have 
come  down  to  our  time  there  are  to  be  found  a  number  of 
autobiographical  references  which  are  not  without  interest. 
In  one  place,  for  example,  he  mentions  the  fact  that  he 
occasionally  walks  in  his  sleep,  and  then  proceeds  (in  Latin) 
to  discuss  the  phenomenon  of  sleep-walking  as  observed  in 
his  own  case.  I  give  here  a  free  translation  of  the  text 
printed  in  Neuburger  's  History : — 

The  fourth  question  which  suggests  itself  is  this :  Can  the  senses 
during  sleep  come  into  active  operation?  Touching  this  fourth 
question  I  reason  thus:  It  appears  as  if,  when  one  is  asleep,  the 
senses  must  act,  for  a  person  may  move  about  without  incurring 
any  harm  when  he  is  in  that  state,  as  is  often  observed  in  the  case 
of  those  who,  like  myself,  walk  in  their  sleep Further- 
more, it  has  been  remarked  that  these  people  are  able  to  harness 
a  horse  and  then  to  ride  the  animal  safely, — acts  which  it  is  not 

2  Aurei.  The  aureus  is  said  to  have  been  worth  about  16  shillings,  English 
money. 


274  GROWTH  OF  MEDICINE 

possible  to  perform  without  the  aid  of  the  senses.  On  the  other 
hand,  Aristotle  maintains  that  a  man,  when  asleep,  is  not  capable 
of  using  his  senses.  To  this  I  reply  by  conceding  that  during 
sleep  a  man  certainly  does  not  perceive  what  is  going  on  about 
him.  "Wherefore,  if  you  answer  me  by  saying  that  the  mere  fact 
of  a  man's  ability  to  walk  while  he  is  asleep  furnishes  conclusive 
evidence  that  he  possesses  his  senses,  I  reply  that  movements  like 
that  of  walking  are  not  the  result  of  an  impression  made  upon  the 
mind  ("impressio  imaginativa"),  but  the  product  of  a  different 
mechanism,  of  a  nature  which  permits  it  to  operate  during  sleep. 

As  to  the   second  point   to   which  you  call  attention — 

that,  namely,  with  regard  to  the  power  of  bridling  and  riding  a 
horse  while  one  is  asleep — I  make  this  reply:  These  acts  are  per- 
formed as  a  result  of  an  impression  made  upon  the  mind  through 
the  working  of  the  imagination,  and  not  as  a  direct  consequence 
of  any  images  created  upon  the  eye ;  for,  if  the  sleep-walker  happens 
to  be  in  a  strange  house  when  the  impulse  to  walk  seizes  him,  he 
will  not  go  to  the  stable.  The  route  which  he  is  sure  to  take  will 
be  one  with  which  he  is  familiar,  as  happened  in  the  case  of  the 
blind  teacher  who,  unaccompanied  by  any  person,  walked  habit- 
ually through  the  streets  of  Bologna.  And  then,  besides,  I  am 
able  to  speak  from  personal  experience,  for  in  one  of  my  sleep 
walks  I  jumped  down  from  an  elevation  about  four  feet  above  the 

ground  without  awaking  from  my  sleep When,   in  the 

course  of  one  of  these  walks,  I  am  exposed  to  cold,  or  when  I  hear 
somebody  speaking  near  me,  I  refer  these  phenomena  entirely  to 
something  within  myself,  and  I  return  to  my  bed. 

Of  the  four  medical  schools  to  which  a  brief  reference 
was  made  on  a  preceding  page,  that  of  Bologna  was 
probably  the  first  to  attain  a  certain  degree  of  celebrity; 
and  it  owed  this  distinction  very  largely  to  the  work  done 
by  men  who  were  primarily  surgeons,  viz. :  Hugo  of  Lucca ; 
Theodoric,  Hugo's  son;  William  of  Saliceto;  and  possibly, 
to  a  very  slight  extent,  Eoland  of  Parma,  who  spent  only 
a  part  of  his  professional  life  in  Bologna.  But  there  was 
one  other  who,  while  he  was  not  a  surgeon,  yet  contributed 
very  greatly  to  the  fame  of  the  Bologna  school  and  at  the 
same  time  to  the  real  advance  in  surgical  knowledge  which 
characterized  the  work  of  the  men  whose  names  have  just 
been   mentioned — viz.,    Mondino.      These   men,    especially 


FURTHER  PROGRESS  OF  MEDICINE        275 

Mondino,  cultivated  the  study  of  anatomy  much  more 
earnestly  than  their  rivals  at  Salerno  had  ever  done,  and 
the  surgical  methods  which  they  adopted  were  of  a  more 
scientific  character  than  those  practiced  by  Roger.  In  the 
treatment  of  wounds,  for  example,  instead  of  striving  to 
bring  about  healing  by  the  application  of  remedies  which 
stimulate  suppuration,  they  favored  the  dry  method;  in 
which  practice  they  were  justified  not  only  by  their  own 
experience  but  also  by  Galen's  teaching:  ''A  dry  state 
of  the  wound  approaches  more  nearly  to  what  may  be 
considered  the  normal  condition,  whereas  a  moist  state  is 
surely  unhealthy."  {Methodi  medend.,  IV.,  5.)  As  an 
offset  to  the  latter  authority  the  Salerno  surgeons  quoted 
that  particular  aphorism  of  Hippocrates  (V.,  67)  which 
reads:  ^^Laxa  bona,  cruda  vero  mala.*' — almost  the  very 
opposite  of  Galen's  doctrine.  Then  again,  the  Bologna 
surgeons  effected  improvements  in  other  directions :  They 
materially  restricted  the  use  of  the  red-hot  cautery  iron, 
and  they  cast  aside  as  useless  many  of  the  complicated 
apparatuses  which  had  previously  been  employed  in  the 
treatment  of  fractures  and  dislocations.  It  is  evident  from 
these  facts  that  the  Bologna  surgeons  were  not,  as  were 
most  of  the  physicians  of  the  twelfth  and  thirteenth  cen- 
turies (Thaddeus  of  Florence  perhaps  excepted),  slavish 
followers  of  the  ancients  or  even  of  the  more  modern  Arabs, 
but  men  who  thought  independently  and  who  were  not 
afraid  to  use  their  own  powers  of  observation. 

Hugo  of  Lucca. — Hugo  Borgognoni,  more  commonly 
called  Hugo  of  Lucca — was  born  in  that  city  about  the 
middle  of  the  twelfth  century,  served  as  municipal  physi- 
cian to  the  city  of  Bologna,  accompanied  the  Bolognese 
Crusaders  on  their  expedition  to  Syria  and  Egypt,  was 
present  at  the  siege  af  Damietta  in  1219  A.  D.,  and  died  a 
short  time  before  1258,  at  the  age  of  nearly  one  hundred. 
He  acquired  a  great  reputation  as  a  surgeon  and  brought 
up  several  sons  who  followed  in  the  same  walk  of  life, 
among  the  number  being  Theodoric,  who  gained  even 
greater  celebrity  than  his  father  in  the  domain  of  surgery. 
As  Hugo  himself  left  no  writings  of  any  kind,  we  are 


276  GROWTH  OF  MEDICINE 

largely  dependent,  for  a  knowledge  of  his  achievements, 
on  the  treatises  which  his  son  Theodoric  wrote.  From  this 
source  we  learn  that  Hugo  recommended,  for  use  in  sur- 
gical operations,  the  employment  of  narcotizing  sponges 
like  those  described  on  page  253,  and  was  also  an  advocate 
of  the  plan  of  treating  wounds  by  the  dry  method  (com- 
presses soaked  in  wine  over  which  simple  dressings  were 
applied).  In  the  treatment  of  empyema,  of  abscesses,  of 
penetrating  wounds  of  the  chest,  and  of  both  complicated 
and  simple  wounds  of  the  skull,  he  emphasized  the  wisdom 
of  adopting  simple  measures,  of  interfering  with  the  parts 
as  little  as  possible,  of  abstaining  from  the  use  of  the  probe, 
and  of  observing  strict  cleanliness.  In  cases  of  fracture 
of  a  rib  it  was  his  practice  to  place  the  patient  in  a  bath, 
and  then,  with  fingers  which  had  been  thoroughly  oiled,  to 
attempt  the  replacement  of  the  separated  ends  of  the 
fractured  bone.  Neuburger  regards  Hugo  of  Lucca  as  the 
founder  of  the  Bologna  School  of  Surgery. 

Theodoric  of  Lucca,  known  also  as  Bishop  Theodoric, 
was  born  1206  A.  D.  While  still  quite  a  young  man  he 
joined  the  recently  established  order  of  preachers,  and  not 
long  afterward  was  appointed  Almoner  {PoenitentiariusY 
to  Pope  Innocent  IV.  Eventually  he  became  Bishop  of 
Cervia,  near  Eavenna.  By  special  permission  of  the  Pope, 
he  was  able  to  complete  the  surgical  training  which  he  had 
received  from  his  father,  Hugo  of  Lucca;  and  thus,  while 
he  still  held  the  office  of  Bishop,  he  practiced  surgery  to 
some  extent  in  Bologna.  In  course  of  time  his  practice 
became  very  extensive  and  also  very  lucrative ;  as  a  result 
of  which  he  was  able  to  leave  a  large  fortune  to  various 
charitable  institutions.  The  first  printed  edition  of  his 
work  on  surgery  appeared  in  Venice  in  1498,  and  was 
followed  by  numerous  later  issues. 

Theodoric,  says  Neuburger,  was  a  most  uncompromising 
advocate  of  the  dry  method  of  treating  wounds.  His 
( Theodoric 's)  words  are  these:  *'For  it  is  not  necessary — 
as  Eoger  and  Roland  have  said,  as  most  of  their  disciples 

3  A  church  official  to  whom  was  intrusted  the  duty  of  granting  dispensa- 
tions; "Almoner"  is  perhaps  the  equivalent  term  in  English. 


FURTHER  PROGRESS  OF  MEDICINE        277 

teach,  and  as  almost  all  modern  surgeons  practice — to  favor 
the  generation  of  pus  in  wounds.  This  doctrine  is  a  very- 
great  error.  To  follow  such  teaching  is  simply  to  put  an 
obstacle  in  the  way  of  nature's  efforts,  to  prolong  the 
diseased  action,  and  to  prohibit  the  agglutination  and  final 
consolidation  of  the  wound."* 

In  his  enumeration  of  the  different  means  that  may  be 
employed  for  arresting  hemorrhage,  Theodoric  mentions 
cauterization,  tamponading,  the  application  of  a  ligature, 
and  the  complete  division  of  the  injured  blood-vessel.  He 
attached  great  importance  to  the  proper  feeding  of  the 
patient.  In  Book  III.,  chapter  49,  of  his  treatise  on  sur- 
gery, he  gives  minute  instructions  with  regard  to  the  proper 
manner  of  employing  a  salve  made  with  quicksilver,  and 
at  the  same  time  he  mentions  the  fact  that  he  observed  a 
flow  of  saliva  as  one  of  the  results  of  its  use. 

The  expressions  ''healing  by  first  intention"  and  ** heal- 
ing by  second  intention"  are  encountered  for  the  first  time 
in  the  writings  of  Brunus,  a  surgeon  who  practiced  in  the 
cities  of  Verona  and  Padua  about  the  middle  of  the  thir- 
teenth century,  and  who  was  a  vigorous  advocate  of  the 
dry  method  of  treating  wounds.  His  two  treatises 
{^^Chirurgia  magna"  and  ^'Chirurgia  minor ^*)  were 
printed  in  Venice  in  1546.  Neuburger  says  that  although 
a  large  part  of  the  text  in  these  volumes  consists  of 
extracts  from  Galen,  Avicenna,  Hippocrates,  Abulcasis 
and  other  authorities,  there  are  to  be  found  at  the  same 
time  not  a  few  observations  of  an  original  character. 

William  of  Saliceto. — William  of  Saliceto  {Guglielmo  da 
Saliceto)  is  accorded  by  Neuburger  the  honor  of  being 
Bologna's  greatest  surgeon — ^if  not,  indeed,  the  greatest 
surgeon  of  that  period.  He  was  born  in  the  early  part  of 
the  thirteenth  century  and  spent  a  large  portion  of  his 
professional  life  in  Bologna,  where  he  not  only  practiced 

4  * '  Non  enim  est  necesse  saniem — sicut  Rogerius  et  Rolandus  scripserunt 
et  plerique  eorum  discipuli  docent,  et  fere  omnes  cururgici  modemi  servant — 
in  vulneribus  generare.  Iste  enim  error  est  major  quam  potest  esse.  Non 
est  enim  aliud,  nisi  impedire  naturam,  prolongare  morbum,  prohibere  con- 
glutinationem  et  consolidationem  vulneris."     (IT.,  cap.  27.) 


278  GROWTH  OF  MEDICINE 

medicine  but  also  acted  in  the  capacity  of  a  teacher  of  this 
science.  During  the  latter  part  of  his  career  he  lived  in 
Verona,  where  he  held  the  position  of  Municipal  Physician 
and  Attending  Physician  of  the  City  Hospital.  He  died 
about  the  year  1280. 

Saliceto's  work  on  surgery  is  of  a  thoroughly  practical 
character  and  reveals  the  author  to  have  been  a  born  sur- 
geon.^ In  addition  to  the  ^^Cyrurgia,"  which  was  first 
printed  in  Piacenza  1476  A.  D.,  he  wrote  a  treatise  which 
bears  the  title  ^^Summa  conservationis  et  curationis" 
(printed  first  in  Piacenza  in  1475).  The  ''Surgery"  is 
divided  into  five  books,  preceded  by  a  short  chapter  on 
general  methods,  etc.  Book  I.  is  devoted  to  affections  of 
the  cranium,  eruptions  on  the  head,  eye  diseases,  ear  dis- 
eases (snaring  of  ear  polypi),  nasal  polypi,  abscesses  in 
the  axilla,  affections  of  the  mammary  gland,  tumors  in 
different  parts  of  the  body,  venereal  lesions  in  the  groin, 
and  a  long  list  of  other  surgical  maladies.  Book  II. 
describes  wounds  of  all  sorts,  including  those  produced  by 
arrows  (with  reports  of  cases),  penetrating  wounds  of  the 
chest  and  abdomen  (with  instructions  about  sewing  both 
longitudinal  and  transverse  wounds  of  the  intestine),  etc. 
Under  the  head  of  penetrating  wounds  of  nerves  (declared 
by  the  author  to  be  very  dangerous),  Saliceto  recommends 
enlargement  of  the  wound,  the  application  of  oil,  and  the 
employment  of  opium  or  hyoscyamus  to  quiet  the  pain. 
Book  III.  treats  the  subject  of  fractures  and  dislocations 
in  a  most  thorough  manner.  Mention  is  made  of  the 
crepitation  noise  heard  in  fractures  {sonitus  ossis  fracti) 
and  a  warning  is  given  not  to  apply  the  bandages  too  tightly 
and  to  be  careful  to  change  the  dressings  every  three  or 
four  days.  The  instructions  given  with  regard  to  the 
reduction  of  dislocations  are  said  by  Neuburger  to  be  most 
sensible.  Book  IV.  contains  such  anatomical  descriptions 
as  may  be  helpful  to  the  practical  surgeon.  From  these, 
however,  it  is  evident  that  the  writer  had  never  dissected 
the  human  cadaver.    Book  V.  is  devoted  to  the  subject  of 

6  The  most  recent  edition  of  this  work  is  a  French  translation  made  by 
P.  Pifteau  and  published  at  Toulouse,  in  3898, 


FURTHER  PROGRESS  OF  MEDICINE        279 

cauterizing  and  to  the  consideration  of  those  remedial 
agents  which  are  commonly  employed  in  surgery.  The 
instruments  used  for  cauterizing  purposes  were  made  of 
different  metals,  gold  or  silver  being  preferred  for  the 
more  delicate  ones,  and  brass  and  iron  for  the  others. 
Immediately  after  the  cauterization  it  was  customary  to 
apply  butter,  or  the  fat  of  some  animal,  or  oil  scented  with 
roses,  to  the  burned  part. 

Saliceto's  other  treatise — the  Summa  conservationis 
etc. — is  also  divided  into  five  books,  which  contain  chapters 
devoted  to  all  the  more  important  branches  of  internal 
medicine  and  to  questions  of  diet,  of  the  physician's 
behavior  in  the  presence  of  a  patient,  etc.  Especially 
interesting  are  his  remarks  about  the  importance  of  con- 
sidering the  psychological  effect  produced  upon  the  patient 
by  such  matters  as  the  physician's  manner  of  feeling  the 
pulse,  his  carefulness  to  inquire  about  the  patient's  various 
symptoms  (how  the  night  was  passed,  what  food  and  drink 
had  been  taken,  etc.) — an  effect  which  oftentimes  is 
*' greater  than  that  produced  by  instruments  and  medi- 
cines." In  discussing  the  subject  of  prognosis,  Saliceto 
makes  the  remark  that  it  is  always  proper  for  the  physician 
to  hold  out  to  the  patient  hope  of  recovery,  although  he 
urges  at  the  same  time  the  wisdom  of  telling  the  whole 
truth  to  the  friends  of  the  patient.  He  also  lays  great 
stress  upon  the  importance  of  **not  holding  any  conversa- 
tion with  the  lady  of  the  house  upon  confidential  matters." 
Neuburger  gives  a  number  of  other  extracts  from  this  most 
interesting  work;  but  I  must  abstain  from  devoting  any 
more  space  to  this  one  mediaeval  author,  whose  manner 
of  writing  makes  it  difficult  to  realize  that  the  treatise  which 
he  has  written  belongs  to  the  thirteenth  century  and  not 
to  a  very  recent  period. 

Roland  of  Parma. — Roland,  who  was  born  in  the  city  of 
Parma  and  who  spent  a  part  of  his  life  in  Bologna,  not 
only  edited  the  work  of  his  teacher,  Roger  of  Salerno,  but 
also  wrote  a  concise  treatise  on  surgery  that  is  entitled 

Rolandina.^'    Neuburger  speaks  of  this  book  as  differing 


II 


280  GROWTH  OF  MEDICINE 

but  little  from  Eoger's  ^^Practica  chirurgiae.^^^  "It  con- 
tains, however,  the  report  of  a  case  of  penetrating  wound 
of  the  chest  in  which  Roland  showed  not  a  little  courage 
by  daring  to  cut  off,  flush  with  the  skin,  a  portion  of  lung 
tissue  which  happened  to  protrude  from  the  wound,  and 
then  applying  a  simple  dressing." 

The  treatise  known  by  the  title  ^^Glossulae  quatuor 
magistrorum  super  chirurgiam  Rogerii  et  Rolandi"  was 
written  by  an  unknown  author  or  perhaps  by  several 
authors.  It  represents  a  collection  of  commentaries  on  the 
works  of  the  two  who  are  mentioned  in  the  title  of  the  book, 
and  should  probably  be  classed  as  a  part  of  the  literature 
of  the  Salerno  School  of  Medicine. 

Mondino  the  Anatomist. — Mondino,  who  was  the  first 
physician,  after  an  interval  of  about  fifteen  hundred  years, 
to  revive  the  practice  of  dissecting  human  bodies,  was  born 
at  Bologna  at  about  1275  A.  D.  He  received  his  profes- 
sional training  at  the  medical  school  of  his  native  city  and 
was  given  the  degree  of  Doctor  in  1290,  at  the  age  of 
fifteen ( !).  Not  long  afterward  he  began  to  teach  anatomy 
in  the  same  institution  and  continued  to  serve  in  this 
capacity  up  to  the  time  of  his  death  in  1326.  The  physicians 
who  aided  him  in  his  anatomical  researches  were  Ottone 
Agenio  Lustrulano,  his  prosector,  and  a  woman  named 
Alessandra  Gilliani,  from  Perriceto. 

Mondino 's  method  of  teaching  anatomy  was  to  deliver 
his  lectures  with  the  dissected  cadaver  directly  before  him ; 
that  is,  he  demonstrated  the  correctness  of  his  statements 
as  fast  as  he  made  them.  (See  Fig.  9.)  Such  a  method 
was  entirely  new  at  the  time  and  proved  immensely  popu- 
lar, attracting  students  to  Bologna  in  large  numbers. 
Partly  in  this  way  and  partly  by  means  of  the  treatise  on 
anatomy  which  he  wrote  {^^Anatomia  MundinV^),  he 
became  the  instructor  of  numerous  generations  of  physi- 
cians. His  treatise  remained  the  authoritative  guide  in 
anatomy  up  to  the  middle  of  the  sixteenth  century. 

6  According  to  Daremberg  (Histoire  des  Sciences  Medicales,  Vol.  I.,  p.  264) 
the  title  ' '  Doctor ' '  appears  for  the  first  time  in  the  Preface  of  Eoger  's  treatise 
(1180  A.  D.). 


c 

J.S6- 


FIG.  9.     THE  OLDEST  KNOWN  PICTORIAL  REPRESENTATION 
OF  A  FORMAL  DISSECTION  OF  THE  HUMAN  BODY. 

The  original,  which  is  in  the  library  of  the  University  of  Montpellier, 
France,  appears  in  a  manuscript  copy  of  Guy  de  Chauliac's  Chirurgia  magna 
(fourteenth  century).  Eugen  Hollander  of  Berlin,  the  author  of  Die  Medi- 
zin  in  der  klassischen  Malerei,  has  courteously  given  permission  to  copy  the 
reproduction.  The  many  defects  which  appear  in  this  picture  are  due  to  the 
fact  that  the  reproduction  was  taken  directly  from  the  original  miniature, 
now  six  hundred  years  old.  Hollander  gives  the  following  description  of 
this  interesting  scene: 

"In  one  of  the  rooms  of  the  hospital  a  woman's  dead  body  is  lying 
upon  a  table.  Alongside  the  bed  in  which  she  died  a  nun  is  praying 
for  her  soul.  Two  physicians  are  busily  engaged  in  the  work  of  dis- 
secting the  body.  ^An  instructor  is  reading  out  of  a  book,  for  the 
benefit  of  the  students  who  are  crowding  into  the  room,  such  por- 
tions of  the  text  as  apply  to  the  case  in  hand,  and  at  the  same  time 
he  is  directing  their  attention  to  the  uterus  which  one  of  the  dissect- 
ors is  Hfting  out  of  the  abdominal  cavity.  Owing  to  the  defective 
state  of  the  original  miniature  it  is  not  possible  to  state  positively 
what  part  the  three  women  who  stand  near  the  head  of  the  corpse 
are  taking  in  the  scene,  but  it  is  not  unlikely  that  they  too  are  physi- 
cians, especially  as  their  presence  on  such  an  occasion  would  be  quite 
in  harmony  with  the  customs  of  that  period  of  time." 


FURTHER  PROGRESS  OF  MEDICINE        281 

In  one  place  in  his  **  Anatomy,"  Mondino  states  explicitly 
that  he  dissected  two  human  cadavers  in  the  month  of. 
January,  1315.  This  statement  renders  it  possible  to  fix 
the  exact  date  when  the  practice  of  making  such  dissec- 
tions— which  had  been  carried  on  for  a  considerable  period 
of  time  about  250  B.  C. — was  first  resumed.  If  one  reflects 
upon  the  nature  of  the  obstacles  which  in  1315  stood  in  the 
way  of  a  revival  of  this  practice, — for  example,  the  deep- 
seated  prejudice  against  it  entertained  by  all  classes  of 
the  community,  and  the  very  strong  opposition  of  the 
ecclesiastic  authorities  to  what  they  honestly  believed  to 
be  a  desecration  of  the  human  body, — one  will  readily 
appreciate  how  great  was  the  courage  displayed  by  Mon- 
dino when  he  almost  openly  undertook  his  first  dissection. 
The  subsequent  career  of  this  famous  teacher  of  anatomy 
justifies  the  belief  that  his  determination  to  take  the  course 
which  he  did  was  based  upon  the  profound  conviction  that 
the  first  step  toward  increasing  the  scanty  stock  of  knowl- 
edge possessed  at  that  time  with  regard  to  the  structure 
of  the  human  body  in  all  its  parts,  must  necessarily  be  one 
in  continuation  of  that  which  Erasistratus  and  his  asso- 
ciates had  taken  centuries  earlier,  but  which  had  not  been 
succeeded  by  a  sufficient  number  of  other  steps  in  the  same 
direction.  The  series  of  discoveries  in  anatomy,  physi- 
ology and  pathology  which  resulted  from  Mondino 's 
courageous  and  intelligent  act,  form  a  part  of  the  history 
of  modern  medicine,  and  do  not  therefore  call  for  consid- 
eration in  this  place.  We  may  simply  add  that  much 
information  of  a  very  interesting  character  is  furnished 
by  Neuburger  {op.  cit.)  with  regard  to  the  manner  in  which 
Mondino  and  his  immediate  successors  carried  on  their 
instruction  in  anatomy  from  that  time  forward. 

The  Medical  School  at  Bologna,  as  may  well  be  imagined, 
gained  great  fame  from  the  possession  of  such  distinguished 
teachers  as  those  whose  careers  I  have  briefly  sketched — 
Hugo  and  Theodoric  of  Lucca,  William  of  Saliceto,  and 
Mondino;  and  it  retained  a  large  part  of  this  celebrity 
throughout  the  fourteenth  and  fifteenth  centuries,  despite 
the  appearance  on  the  scene,  toward  the  end  of  this  time, 


282  GROWTH  OF  MEDICINE 

of  several  formidable  claimants  for  high  honors  in  the 
domain  of  medical  research  and  education — viz.,  the  schools 
at  Montpellier  and  Paris,  in  France,  and  that  of  Padua,  in 
Italy. 

Lanfranchi  and  the  Medical  School  of  Paris. — According 
to  Edouard  Mcaise^  medicine  was  not  taught  publicly  at 
Paris  previously  to  1160  A.  D.  The  teaching  was  carried 
on  at  that  time  by  associations  of  physicians,  and  it  was 
only  during  the  following  century  (about  1250  A.  D.)  that 
something  like  a  university  was  established  in  that  city. 
Up  to  the  end  of  the  sixteenth  century  (1595  A.  D.),  during 
the  reign  of  Henry  IV.,  this  institution  remained  under 
the  control  of  the  Church.  Its  functions — so  far  at  least 
as  medicine  was  concerned — were  limited  to  the  bestowing 
of  degrees,  for  it  possessed  at  that  time  no  organization 
of  instructors  and  no  permanent  quarters  in  which  the 
teaching  might  be  carried  on  systematically;  a  church 
(see  Fig.  10)  or  the  Dean's  residence  serving  as  the  locality 
in  which  the  lectures  were  commonly  delivered. 

During  the  middle  part  of  the  thirteenth  century  and  for 
a  long  time  afterward,  the  practice  of  surgery,  which  was 
then  of  a  rather  primitive  type,  was  entirely  in  the  hands 
of  two  classes  of  men — the  barbers  and  the  so-called 
surgeons.*  As  time  went  on,  the  surgeons  began  to  feel 
the  necessity  of  securing  better  protection  for  their  material 
interests,  which  were  being  more  and  more  encroached 
upon  by  the  barbers — a  class  of  men  who  were  not  privi- 
leged by  the  authorities  to  include  in  their  field  of  acti^dties 
anything  beyond  hair-cutting,  shaving,  cupping,  the  extrac- 
tion of  teeth,  the  application  of  leeches,  the  incision  of  boils 
and  perhaps  one  or  two  other  simple  operations.  For  this 
reason,  therefore,  and  also  probably  because  they  too  felt 

T^'La  Grande  Chirurgie  de  Chiy  de  Chauliac,"  Paris,  1890. 

8  The  distinguishing  sign  of  the  barbers  was  the  shaving  dish,  made  of 
pewter  and  hung  up  at  the  door  of  the  shop;  that  employed  by  the  surgeons 
was  also  a  shaving  dish,  but  made  of  polished  brass.  Those  surgeons  who  had 
received  their  training  at  the  school  of  Saint  Cosmas  and  Saint  Damian  were 
permitted  to  display  at  the  window  a  banner  bearing  the  coat  of  arms  of  this 
institution. 


FURTHER  PROGRESS  OF  MEDICINE        283 

in  some  measure  the  effects  of  the  Renaissance  spirit  which 
was  then  abroad  in  the  land,  they  organized  themselves 
(1254  A.  D.)  into  an  association  which  bore  the  name  of 
''College  of  Saint  Cosmas"  {College  de  St.  Come).^  One 
of  the  early  acts  of  this  association  was  to  establish  the 
rule  that  all  applicants  for  membership  should  pass  suc- 
cessfully an  examination  as  to  their  fitness  before  they 
could  be  admitted.    Very  little  is  known  about  the  doings 


FIG.  10.    THE  MANNER  OP  GIVING  PUBLIC  INSTRUCTION 
IN  MEDICINE  DURING  THE  MIDDLE  AGES. 

(From  Meaux  Saint-Marc's  L'Aco/e  de  Salerne.) 
The  present  cut  is  evidently  a  modern  copy  of  a  much  earlier  original. 


of  the  organization  during  the  early  years  of  its  existence. 
Later,  as  we  shall  see,  it  played  a  very  important  part  in 
the  history  of  medicine  in  France. 

»  The  surgeons  Cosmas  and  Damian  were  chosen  patron  saints  of  the  new 
organization.  They  were  born  in  Arabia  in  the  third  century,  and  are  said 
to  have  been  educated  there.  After  having  practiced  medicine  for  a  certain 
length  of  time  in  Sicily,  they  were  tortured  and  killed,  because  of  their  Chris- 
tian faith,  by  order  of  the  Emperor  Diocletian,  303  A,  D.  Hence  the  title 
"Saints." 


284  GROWTH  OF  MEDICINE 

From  the  account  given  by  Nicaise  it  appears  that  no 
regular  instruction  in  anatomy  was  given  in  the  University 
of  Paris  until  after  the  fourteenth  century,  and  then  only 
from  three  to  five  times  a  year,  when  the  body  of  a  person 
who  had  been  hung  was  publicly  dissected.  ''Such  a 
dissection  lasted  seven  days  and  was  a  veritable  scientific 
festival."  No  official  cliniques  were  held  and  the  only 
way  in  which  the  student  of  medicine  could  obtain  some 
practical  acquaintance  with  disease  and  with  the  methods 
of  treatment  was  by  attaching  himself  to  a  physician  or  a 
surgeon,  or  to  a  barber. 

From  the  preceding  brief  and  very  incomplete  account 
the  reader  will,  I  trust,  be  able  to  form  some  idea  of  the 
condition  of  affairs,  medical  and  surgical,  in  Paris  at  the 
time  when  Lanfranchi  arrived  in  that  city. 

Lanfranchi,  says  Neuburger,  was  born  in  Milan,  Italy, 
and  was  undoubtedly  the  most  distinguished  among  the 
pupils  of  Saliceto  at  Bologna.  After  leaving  the  medical 
school  he  practiced  both  medicine  and  surgery  for  a  certain 
length  of  time  in  his  native  city;  but  finally,  becoming 
involved  in  the  quarrels  between  the  Guelphs  and  the 
Ghibellines,  he — ^like  many  other  Italian  physicians — ^was 
obliged  to  take  refuge  in  France.  In  Lyons,  which  was  his 
first  place  of  residence,  he  engaged  for  a  short  time  in  the 
practice  of  medicine  and  also  wrote  his  first  treatise  on 
surgery — ' '  Chirurgia  Parva. ' '  Then,  after  traveling  from 
one  place  to  another  in  the  provinces,  he  finally  (1295  A.  D.) 
settled  permanently  in  Paris.  In  that  city  he  very  soon 
acquired  a  large  practice,  and,  at  the  same  time,  built  up 
for  himself  a  great  reputation  as  a  teacher  of  medicine. 
The  College  de  St.  Come  elected  him  a  member  of  that 
organization  and  profited  greatly  from  the  fame  which  his 
teaching  brought  to  the  institution.  It  is  said  that  Jean 
Passavant,  who  was  at  that  time  the  Dean  of  the  Medical 
Faculty  of  Paris,  aided  Lanfranchi  in  his  work  by  every 
means  in  his  power.  As  a  result  Paris,  during  a  consider- 
able period  of  time,  was  one  of  the  few  places  in  which 
genuine  clinical  instruction  was  given  to  all  those  who 
desired  to  acquire  a  practical  acquaintance  with  disease. 


FURTHER  PROGRESS  OF  MEDICINE        285 

His  larger  treatise,  the  *  *  Chirurgia  Magna, ' '  was  completed 
in  1296.  It  was  dedicated  to  the  Eang  of  France,  Philip  IV., 
commonly  called  ^^Phillippe  le  Bel/'  and  its  intrinsic  merits 
assured  him  a  permanent  reputation  as  a  surgeon.  This 
work,  which  was  translated  years  ago  into  English  and  has 
recently  (1894)  been  published  by  the  ''Early  English  Text 
Society,"  under  the  title  *'Lanf rank's  Science  of  Cirurgie," 
consists  of  five  separate  fasciculi  or  parts.  A  few  extracts 
from  the  text  of  this  celebrated  work  may  prove  of  interest 
to  the  reader.  Not  having  access  to  the  English  version 
just  mentioned,  I  shall  have  to  translate  from  the  version 
(partly  Latin  and  partly  German)  supplied  by  Neuburger. 
Part  I.  of  the  Chirurgia  Parva  mentions  some  of  the 
characteristics  which  a  surgeon  should  possess.  He  should, 
for  example,  have  well-formed  hands,  with  fingers  that  are 
long  and  slender ;  his  body  should  be  strong  and  firm  in  its 
movements;  his  hands  and  fingers  should  respond  quickly 
to  the  workings  of  the  mind ;  his  mind  should  be  of  a  subtle 
type;  in  character  he  should  not  be  over-bold,  but  self- 
reliant  and  yet  modest;  he  should  have  a  good  supply  of 
common  sense;  he  should  be  well-informed  not  only  in 
medicine,  but  also  in  all  the  branches  of  philosophy;  he 
should  be  a  good  logician;  he  should  be  familiar  with  the 
writings  of  medical  authors;  he  should  be  virtuous  and 
ethical;    he    should    be    trustworthy;    he    should    not    be 

avaricious  nor  envious; and,  finally,  he  should  be 

thoroughly  familiar  with  all  the  diseases  to  which  the 
human  body  is  liable.  In  one  place  Lanfranchi  refers  to 
the  fact  that  exposure  to  the  air  favors  the  production  of 
pus  in  a  wound.  Among  the  methods  which  may  be 
employed  for  arresting  hemorrhage  he  mentions  digital 
compression  and  ligaturing  of  the  bleeding  vessels.  He 
recommends  that  a  wounded  individual  should  abstain  from 
wine  and  from  an  over-nutritious  diet.  No  attempt,  he  says, 
should  be  made  to  extirpate,  with  the  knife  or  by  means 
of  the  actual  cautery,  an  ulcerated  cancer,  unless  it  appears 
probable  that  by  such  means  complete  destruction  of  the 
tumor  may  be  effected.     In  traumatic  tetanus  dependent 


286  GROWTH  OF  MEDICINE 

upon  an  injury  of  a  tendon  or  nerve  trunk  he  recommends 
complete  division  of  the  wounded  structure. 

Part  II.  is  devoted  to  the  consideration  of  wounds  of  the 
different  parts  of  the  body,  taken  in  regular  order  from 
the  head  to  the  feet.  The  descriptions,  in  each  instance, 
are  preceded  by  an  adequate  account  of  the  region  affected. 
In  his  discussion  of  fractures  of  the  skull  he  speaks  of  the 
diagnostic  value  of  the  rough  and  jarring  sound  perceived 
by  the  patient  when  the  physician  taps  with  a  rod  upon  the 
injured  skull;  and  he  also  states  that  an  aid  to  diagnosis 
may  be  derived  from  the  fact  that  a  person  whose  skull  is 
fractured  experiences  pain  at  the  seat  of  the  injury  when 
somebody  passes  the  ends  of  his  finger-nails  along  a  string 
which  the  patient  holds  suspended  between  his  teeth.^" 
According  to  Neuburger  the  description  which  Lanfranchi 
gives  of  the  various  symptoms  observed  in  cases  of  fracture 
of  the  skull  is  admirable.  In  the  section  relating  to  the 
treatment  of  such  fractures  he  warns  against  the  tendency 
to  resort  too  readily  to  the  use  of  the  trephine,  and 
expresses  the  belief  that  this  instrument  should  be  employed 
only  when  the  fractured  bone  is  depressed  or  when  there 
is  evidence  of  irritation  of  the  dura  mater. 

Part  III.  deals  with  skin  diseases  and  various  forms  of 
tumors,  including  those  of  the  thyroid  gland;  and  with 
diseases  of  the  eye,  the  ear  and  the  nasal  cavities;  with 
the  various  kinds  of  hernia;  with  renal  and  cystic  calculi; 
with  hemorrhoids,  varicose  veins,  etc.;  with  abdominal 
dropsy;  and  with  still  other  affections.  In  bloodletting  he 
recommends  the  practice  of  opening  the  vein  longitudi- 
nally. He  is  very  emphatic  in  his  manner  of  insisting  that 
medicine  and  surgery  should  not  be  divorced,  and  that  the 
operation  of  drawing  blood  should  not  be  intrusted  to 
barbers. 

After  the  death  or  retirement  of  Lanfranchi  during  the 
first  decade  of  the  fourteenth  century,  Paris  appears  to 
have  played,  at  least  for  a  few  years,  a  comparatively  small 
part  in  the  history  of  medical  teaching.     Her  rivals  at 

10  Guy  de  Chauliac,  who  wrote  a  treatise  on  surgery  in  the  latter  half  of 
the  fourteenth  century,  also  speaks  of  the  value  of  this  diagnostic  sign. 


FURTHER  PROGRESS  OF  MEDICINE        287 

Montpellier,  in  the  south  of  France,  and  at  Bologna  and 
Padua,  in  Italy,  far  outstripped  her  during  this  period. 
There  was  one  physician  at  Paris,  however, — Henri  de 
Mondeville, — who  would  probably  have  proved  a  worthy 
successor  of  Lanfranchi  if  circumstances  had  not  seriously 
interfered  with  his  acting  the  part  of  a  teacher. 

Henri  de  Mondeville. — Henri  de  Mondeville,  says 
Edouard  Nicaise,  was  born  about  1260  A.  D.  in  Normandy. 
In  his  native  village — Mondeville  or  Mandeville,  or  Amon- 
daville,  all  of  which  names  are  found  in  the  manuscripts — 
he  was  known  simply  as  Henri,  but  in  the  outside  world 
and  in  medical  literature  he  is  mentioned,  in  accordance 
with  the  prevailing  custom  of  that  period,  as  Henri  de 
Mondeville.  After  studying  medicine  for  a  certain  length 
of  time  in  Paris  and  Montpellier,  he  went  to  Italy  and 
became  the  pupil  of  Theodoric  of  Bologna.  He  is  said  to 
have  been  passionately  fond  of  surgery,  which  at  that 
period  was,  in  France,  a  much  despised  branch  of  medicine. 
In  Italy,  on  the  contrary,  such  men  as  William  of  Saliceto, 
Hugo  of  Lucca,  Theodoric  and  Lanfranchi  had  raised  sur- 
gery to  a  position  of  great  honor,  and  Henri  de  Mondeville 
cherished  the  hope  that  he  also  might  be  able  to  accomplish 
the  same  result  in  France,  Upon  his  return  to  Paris  he 
was  chosen  one  of  the  physicians  (there  were  four  in  all) 
of  the  royal  household,  and  from  that  time  onward  he  was 
frequently  obliged  to  set  aside,  for  longer  or  shorter 
periods,  all  his  personal  interests  (private  practice,  lec- 
turing to  medical  students,  hospital  service  at  Hotel-Dieu, 
etc.)  in  order  to  attend  the  King  or  the  Comte  de  Valois  on 
some  military  expedition.  This  sort  of  service,  however, 
was  by  no  means  time  lost,  for  it  afforded  him  the  oppor- 
tunity to  acquire  great  experience  in  the  treatment  of 
wounds,  an  experience  which  reveals  itself  on  almost  every 
page  of  his  treatise  on  surgery.  And  yet  there  came  a  time 
(1312)  when  de  Mondeville  complained  bitterly  of  these 
interruptions,  for  which  he  received  no  pay  and  which 
interfered  seriously  with  his  literary  work.  Despite  these 
hindrances,  he  appears  to  have  made  a  fair  degree  of 
progress  in  the  writing  of  his  book,  for  at  the  date  last 


288  GROWTH  OF  MEDICINE 

named  lie  gave  a  public  reading  of  the  first  two  sections 
**  before  a  large  and  noble  assemblage  of  medical  students 
and  other  distinguished  personages."  The  portrait  of 
de  Mondeville  which  is  here  reproduced  is  a  copy  of  the 
miniature  which  appears  in  one  of  the  manuscripts  of  his 
treatise  that  was  prepared  1314  A.  D.,  and  is  now  preserved 
in  the  Bibliotheque  Nationale  at  Paris.  Nicaise  furnishes 
the  following  details  regarding  the  original  miniature. 

Inasmuch  as  the  MS.  bears  the  date  1314  the  portrait  must  have 
been  painted  while  De  Mondeville  was  still  living.  The  master  is 
represented  wearing  a  violet-colored  gown,  red  stockings,  and  a 
black  skull-cap.  He  is  thin,  his  beard  is  scanty  and  of  a  grey 
color  like  the  hair  of  his  head,  his  features  are  finely  cut,  and  he 
appears  to  be  a  fairly  tall  man.  So  far  as  one  may  judge  from 
this  portrait  De  Mondeville 's  age  was  then  about  fifty. 

The  date  of  his  death  is  not  known  exactly,  but  it  must 
have  been  somewhere  about  1320  A.  D. 

Nicaise  sums  up  de  Mondeville 's  personal  history  and 
his  contributions  to  the  science  of  medicine  somewhat  as 
follows :  He  was  a  man  of  warm  impulses,  who  loved  the 
truth  and  despised  all  shams.  He  never  hesitated  to  speak 
his  opinion  about  others,  the  King  himself  not  being 
excluded  from  his  criticisms.  He  wa&  also  quite  frank  in 
his  exposures  of  the  ignorance  of  both  nobles  and  members 
of  the  clergy.  He  was  not  in  the  least  degree  superstitious. 
He  remained  unmarried  throughout  life  and  seems  to  have 
entertained  a  slight  disposition  to  find  fault  with  women, 
for  he  attacks  somewhat  violently  their  mode  of  life  and 
their  extravagance,  especially  in  the  case  of  the  women  of 
Montpellier.  Although  he  possessed  a  great  reputation 
and  a  very  large  clientele  of  patients,  he  did  not  acquire 
a  fortune.  He  is  quoted  as  saying:  **I  was  obliged  from 
the  very  first  to  work  hard  for  a  living."  Suppuration, 
according  to  the  view  of  de  Mondeville,  was  not  a  necessary 
phenomenon  in  the  healing  of  wounds. 

About  the  year  1316  the  condition  of  de  Mondeville 's 
health — he  probably  had  pulmonary  tuberculosis — ^began 
to  give  him  serious  cause  for  anxiety  lest  he  might  not  live 


FIG.  11.    HENRI  DE  MONDEVILLE. 

(From  Nicaise's  Version,  Paris,  1893.) 

From  a  miniature  at  the  head  of  a  manuscript  which  bears  the  date 
A.  D.  1313,  now  preserved  in  the  Bibliothfeque  Nationale  at  Paris. 


FURTHER  PROGRESS  OF  MEDICINE        289 

long  enough  to  complete  his  book ;  and,  as  a  matter  of  fact, 
the  treatise  which  we  now  possess  shows  that  his  fears 
proved  to  be  well  grounded.  The  important  subjects  of 
fractures,  dislocations  and  hernia,  for  example,  are  men- 
tioned only  casually.  Those  subjects,  however,  which  he 
did  discuss  are  treated  in  a  very  clear  and  practical  manner. 
Thus,  for  example,  his  instructions  with  regard  to  the 
proper  manner  of  treating  wounds  is  most  satisfactory. 
Theodoric  and  he  were  the  great  champions  of  the  so-called 
dry  treatment,  which  had  been  introduced  at  some  remote 
period  of  antiquity,  but  which  apparently  had  not  met  with 
general  acceptance.  Then,  again,  in  his  remarks  on  the 
subject  of  amputations,  he  taught  that  the  ligaturing  of 
the  severed  arteries  after  the  removal  of  the  amputated 
part,  was  universally  recognized  as  the  proper  course  to 
adopt  and  should  never  be  neglected. 

In  Chapter  VII.  of  the  first  section  of  his  treatise,  de 
Mondeville  gives  a  description  of  the  anatomy  of  the  heart 
and  related  blood-vessels,  and  at  the  same  time  furnishes 
an  unusually  clear  account  of  the  physiology  of  the  circu- 
lation which  was  universally  accepted  by  the  physicians 
of  that  period,  as  it  had  already  been  by  those  of  earlier 
centuries.  It  seems  desirable  to  reproduce  this  account 
here  in  order  that  it  may  serve  for  purposes  of  comparison 
with  that  which  Harvey  was  to  give  three  centuries  later. 
It  is  only  by  making  such  a  comparison  that  the  physicians 
of  our  time  can  appreciate  the  vast  importance  which 
attaches  to  Harvey's  wonderful  discovery.  De  Monde- 
ville's  account,  abbreviated  wherever  it  seemed  practicable 
to  do  this,  reads  as  follows : — 

The  heart  is  the  most  important  of  all  the  organs.  It  transmits 
to  the  other  members  of  the  body  vitalizing  blood,  heat  and  spirit. 
Its  muscular  tissue,  unlike  ordinary  muscle,  is  composed  of  three 
kinds  of  fibres,  and  it  is  not  under  the  control  of  the  will.  It  has 
the  shape  of  a  pineapple  and  is  located  in  the  centre  of  the  chest, 
like  a  prince  in  the  middle  of  his  kingdom.  Its  lower  extremity 
is  directed  somewhat  to  the  left  of  the  chest,  as  we  are  assured  by 
the  Philosopher  (Aristotle)  in  his  history  of  animals.  There  are 
two  reasons  why  it  points  toward  the  left :    1.,  in  order  that  it  may 


290  GROWTH  OF  MEDICINE 

not  press  upon  the  liver  or  be  pressed  upon  by  it ;  and  2.,  in  order 
that  it  may  not  communicate  its  heat  to  the  left  side  (the  cool  side) 
of  that  organ. 

It  is  important  to  note  the  fact  that  the  heart  is  the  only  structure 
which  contains  blood  in  its  substance ;  in  all  the  other  members  of 
the  body  the  blood  is  contained  in  the  veins.  The  base  of  the  heart 
is  situated  at  its  highest  point  and  represents  the  broadest  portion 
of  the  organ ;  it  is  attached  to  the  posterior  wall  of  the  chest  by  a 
few  ligaments,  than  which  no  stronger  are  to  be  found  in  any  part 
of  the  body.  These  bands  do  not  touch  the  heart  at  any  point 
except  at  the  top,  where  they  take  their  origin;  and  their  great 
strength  is  explained  by  the  fact  that  it  is  their  duty  to  hold  the 
heart  firmly  in  its  proper  position. 

The  heart  possesses  two  ventricles  or  cavities,  of  which  the  left 
one — by  reason  of  the  natural  position  of  the  organ  as  a  whole — 
is  a  little  higher  than  the  right.  Between  these  two  cavities  there 
is  placed  a  partition  which  in  its  turn  contains  a  small  cavity — 
termed  by  some  the  third  ventricle.  Above  each  of  the  larger 
ventricles  there  is  a  sort  of  appendix — cartilaginous  in  structure, 
but  flexible  and  at  the  same  time  strong, — which  contains  a  cavity 
and  has  some  resemblance  to  a  cat's  ear.  These  structures,  to 
which  the  common  people  have  given  the  name  auricles,  alternately 
contract  and  dilate.  The  purpose  for  which  they  exist  is  to  serve 
as  reservoirs  for  the  blood  and  air  that  are  needed  for  the  nourish 
ment  and  cooling  of  the  heart. 

To  the  right  ventricle  there  comes  a  many-branched  vein  which 
conducts  to  the  heart  a  coarse,  thick  and  warm  blood  destined  to 
nourish  that  organ.  The  portion  of  this  abundant  fluid  which  is 
not  needed  for  this  purpose  is  then  rendered  less  coarse  and  thick 
by  some  subtle  power  possessed  by  the  heart  itself,  after  which  it 
is  driven  into  the  cavity  that  is  located  within  the  partition  wall 
which  separates  the  ventricles  the  one  from  the  other.  From  this 
smaller  cavity,  this  so-called  third  ventricle,  in  which  it  receives 
additional  heat  and  at  the  same  time  undergoes  further  thinning 
as  well  as  some  kind  of  digestion  and  purification,  the  blood  passes 
on  into  the  left  ventricle  and  there  undergoes  a  further  change — 
one  which  is  characterized  by  the  development  of  that  element 
which  we  call  spirit,  something  clearer,  more  subtle,  more  pure, 
more  glorious  than  any  known  substance  in  the  human  body, 
and  therefore  more  nearly  allied  in  its  nature  to  celestial  things. 
This  new  element  forms  a  friendly  and  very  appropriate  link 
between  the  body  and  the  soul ;  it  is  the  direct  agent  or  instrument 


FURTHER  PROGRESS  OF  MEDICINE        291 

of  the  latter,  conveying  to  man  the  different  faculties  with  which 
he  may  be  endowed. 

From  the  left  ventricle  of  the  heart,  alongside  its  auricle,  two 
arteries  are  given  off.  One  of  them,  which  is  only  furnished  with 
one  tunic  (as  in  the  case  of  a  vein)  and  which  is  called  the  arteria 
venalis  (pulmonary  vein),  carries  to  the  lungs  the  blood  which 
they  require  for  their  nourishment,  and  breaks  up  into  many 
branches  after  entering  these  structures;  the  other  artery  is  pro- 
vided with  two  tunics  and  is  called  the  grand  artery  (the  aorta). 
From  the  latter  vessel  are  given  off  the  numberless  arteries  which 
are  distributed  throughout  the  entire  body — ^vessels  which  trans- 
port to  every  organ  and  structure  both  the  blood  which  they  need 
for  their  nourishment  and  the  spirit  required  for  their  revivifica- 
tion. When  this  spirit  passes  into  the  ventricles  of  the  brain  it 
is  subjected  to  a  new  species  of  digestion,  which  converts  it  into 
the  spirit  of  the  soul.  Similarly,  when  it  enters  the  liver  it  becomes 
a  nutritive  spirit;  when  it  enters  the  testicles,  a  generative  spirit, 
and  so  on  through  all  the  different  organs. 


CHAPTER  XXIV 

DURING  THE  LATTER  HALF  OF  THE  MIDDLE 
AGES  SURGERY  ASSUMES  THE  MOST  PROMI- 
NENT PLACE  IN  THE  ADVANCE  OF  MEDICAL 
SCIENCE 

During  the  first  half  of  the  fourteenth  century,  as  has 
been  shown  in  the  preceding  chapter,  Henri  de  Mondeville 
was  largely  successful  in  rendering  Paris  the  most  promi- 
nent centre  of  medical  activity  in  France,  if  not  in  Western 
Europe  generally.  His  life,  however,  was  short,  and  his 
position  as  one  of  the  leading  surgeons  of  the  French  Army 
subjected  him  to  many  and  prolonged  interruptions,  for 
which  reasons  he  was  not  able  to  complete  his  excellent 
treatise  on  surgery.  No  physician  of  the  same  intellectual 
capacity  and  of  equally  strong  character  appears  to  have 
been  living  in  Paris  at  the  time  of  De  Mondeville 's  death, 
and  consequently  the  importance  of  that  city  as  a  centre 
of  medical  education  diminished  rapidly  after  that  event. 
On  the  other  hand,  the  Medical  School  at  Montpellier  in 
the  southern  part  of  France  began  at  about  this  period, 
under  the  influence  of  Arnold  of  Villanova  (probably  a 
small  town  in  Catalonia,  Spain,  in  the  diocese  of  Valencia), 
to  acquire  importance. 

Arnold  of  Villanova  and  the  Medical  School  of  Mont- 
pellier.— Arnold  of  Villanova  was  born  about  1240  A.  D., 
of  humble  parentage.  He  obtained  his  early  education  in 
a  Dominican  cloister,  and  afterward  devoted  all  his  energies 
to  the  study  of  languages  (especially  Hebrew),  theology, 
philosophy,  the  natural  sciences  (physics,  alchemy),  and 
medicine.  Paris  and  Montpellier  were  the  principal  cities 
in  which  he  prosecuted  those  studies.     Already  as  early 


ADVANCE  OF  SURGERY  293 

as  the  year  1270,  Arnold  had  attained  considerable  celeb- 
rity as  a  physician.  Between  the  years  1289  and  1299  he 
appears  to  have  made  his  home  in  Montpellier,  and  to  have 
been  very  actively  engaged  both  as  a  practicing  physician 
and  as  a  teacher  of  medicine.  It  was  in  that  city  also  that 
he  wrote  the  more  important  of  his  numerous  medical 
treatises.  At  a  later  period  of  his  life  he  appears  largely 
to  have  lost  his  interest  in  medicine,  for  in  1299  we  find 
him  acting  as  an  ambassador  from  the  King  of  Aragon, 
whose  private  physician  he  was,  to  the  Court  of  Philippe 
le  Bel,  King  of  France,  and  deeply  entangled,  during  his 
stay  in  Paris,  in  disputes  with  the  theologians  of  that  city 
respecting  certain  religious  doctrines.  He  was  also  at  the 
same  time  busily  engaged  in  championing  various  eccle- 
siastic reforms  which  he  was  anxious  to  see  inaugurated. 
His  opponents  haled  him  before  the  tribunal  of  the 
Inquisition  and  succeeded  in  having  him  cast  into  prison, 
where  he  remained  until  he  expressed  a  willingness  to 
retract  the  obnoxious  opinions  which  he  had  advanced. 
The  same  tribunal  pronounced  his  treatise  '*Z)e  Adventu 
Antichrists^  to  be  heretical.  After  these  persecutions 
Arnold  endeavored  to  procure  aid  and  comfort  from  Popes 
Boniface  VIII.  and  Benedict  XI.  The  former  was  inclined 
in  his  favor,  but  Benedict  manifested  no  disposition  to  aid 
him.  Boniface's  sentiments  were  doubtless  influenced  by 
the  fact  that  Arnold  had  treated  him  successfully  for  stone 
in  the  bladder;  and  Neuburger  incidentally  states  that,  in 
the  effecting  of  this  cure,  not  only  medical  and  dietetic 
treatment  had  been  employed,  but  also  two  other  meas- 
ures— viz.,  the  application  of  a  bandage  or  truss  which 
encircled  the  loins  snugly,  and  the  wearing  (by  the  patient) 
of  a  magic  seal  ring  upon  which  was  engraved  the  effigy 
of  a  lion.^  When  Pope  Clement  V.  (1305-1315  A.  D.) 
removed  the  papal  seat  from  Rome  to  Avignon,  in  France, 
Arnold  was  relieved  from  the  charge  of  heresy  and 
reinstated  in  the  respect  of  his  contemporaries.  He  became 
the  trusted  adviser  of  royalty,  won  the  sympathy  of 
Jayme  II.  and  of  his  brother,  Frederic  III.,  King  of  Sicily, 

1  See  remarks  on  the  subject  of  amulets,  etc.,  on  pages  197,  198. 


294  GROWTH  OF  MEDICINE 

for  Ms  broad-minded  views  regarding  religious  matters, 
and  was  both  hated  and  feared  by  his  enemies.  According 
to  trustworthy  chronicles,  Arnold  of  Villanova  died  at  sea 
in  1311,  within  sight  of  the  coast  of  Genoa,  while  he  was  on 
a  voyage  (probably  from  Sicily)  to  visit  the  Court  of 
Clement  V.  In  1316  the  Inquisition  pronounced  most  of 
his  philosophical  and  theological  writings  heretical,  and 
ordered  them  to  be  destroyed. 

A  complete  collection  of  the  medical  writings  of  Arnold 
of  Villanova,  so  far  at  least  as  they  were  then  known  to 
exist,  was  printed  at  Lyons,  France,  in  1586.  It  is  said 
that  many  of  the  treatises  which  this  author  wrote  have 
been  lost.  Of  those  which  have  come  down  to  our  time 
there  are  only  three  which  call  for  any  special  comment — 
Arnold's  ^^Breviarium,"  a  compendium  of  the  practice  of 
medicine;  his  ^^ Commentary  on  the  Regimen  Salernita- 
num, ' '  the  sales  of  which,  according  to  Neuburger,  reached 
an  enormous  figure ;  and  a  work  which  bears  the  title 
^^Paraholae  medicationis  secundum  instinctum  veritatis 
aeternae,  quae  dicuntur  a  medicis  regulae  generates  cura- 
tionis  morhorum.''^  (Basel,  1560.)  The  latter  treatise, 
which  might  with  propriety  be  given  the  simple  title  of 
** General  Rules  regarding  the  Treatment  of  Diseases,"  is 
dedicated  (1300  A.  D.)  to  Philippe  le  Bel,  King  of  France. 
It  contains  a  number  of  chapters  on  the  principles  of 
general  pathology,  and  others  on  special  pathology  and 
therapeutics,  \vith  relation  both  to  internal  diseases  and 
to  those  which  particularly  interest  the  surgeon.  It  also 
furnishes  345  aphorisms,  many  of  which  embody  truths 
of  the  highest  importance  and  reveal  the  author  to  have 
been  a  man  of  independent  judgment,  of  wide  experience, 
and  of  a  philosophical  type  of  mind. 

In  the  '^Parabolae"  and  the  '^Breviarium/*  says  Neu- 
burger, are  to  be  found  the  most  marked  evidences  of  the 
knowledge  and  ability  which  this  great  physician  possessed. 
He  then  adds : — 

Arnold  attached  much  importance  to  hygiene  and  the  proper 
regulation  of  the  diet  as  effective  measures  in  preventing  diseases, 
and  he  formulated  an  admirable  set  of  rules  for  the  ordering  of 


ADVANCE  OF  SURGERY  295 

one 's  manner  of  living.  In  these  he  gives  prominence  to  the  value 
of  baths,  to  the  importance  of  taking  a  certain  amount  of  physical 
exercise,  and  to  the  selection  of  the  right  kinds  of  food.  He  also 
describes  in  detail  how  wine  may  be  utilized  advantageously  in 
cases  of  illness.  As  regards  the  choice  of  remedies  to  be  employed 
he  says  that  the  physician  should  be  guided  by  a  very  careful 
consideration  of  the  patient's  age,  temperament,  habits  of  living, 
etc. ;  and,  so  long  as  there  remains  any  doubt  about  the  correctness 
of  the  diagnosis,  he  should  employ  only  mild  and  indifferent 
remedies.  The  greatest  care,  he  adds,  should  be  exercised  in  the 
preparation  of  the  drugs  that  are  to  be  administered,  and  one 
should  be  very  cautious  about  prescribing  substances  which  have 
not  been  sufficiently  tried. 

Arnold's  writings  are  full  of  precepts  which,  like  those 
quoted  above,  show  him  to  have  been  an  excellent  practi- 
tioner of  medicine  as  well  as  a  man  of  sound  common  sense. 
And  yet  at  the  same  time  he  appears  to  have  been  more  or 
less  tainted  with  the  prevailing  belief  in  astrology,  in  the 
efficacy  of  amulets  (as  in  the  case  of  Pope  Boniface  referred 
to  on  a  previous  page), "etc.  His  enemies  gave  him  the 
reputation  of  being  a  sorcerer  upon  whom  the  Devil  had 
bestowed  the  power  of  transmuting  metals, — a  reputation 
which  undoubtedly  was  based  upon  the  fact  that  Arnold 
interested  himself  greatly  in  alchemistic  processes,  often 
referring  to  them  as  closely  resembling  such  organic 
phenomena  as  generation,  birth,  growth,  etc.  But,  in  our 
judgment  of  the  man,  we  should  be  careful  to  remember  that 
during  the  thirteenth  century  a  belief  in  alchemy,  astrology, 
the  efficacy  of  amulets,  the  influence  of  supernatural 
agencies,  etc.,  was  almost  universal.  Even  theologians 
maintained  that  it  was  a  sin  for  a  practitioner  of  medicine 
to  neglect  the  influence  of  certain  constellations.  Indeed, 
there  are  even  to-day,  not  a  few  very  sensible  people  in 
whose  minds  exists  a  lingering  belief  in  the  interference  of 
supernatural  agencies  in  human  affairs. 

The  importance  of  the  influence  which  Arnold  of  Villa- 
nova  exerted  upon  the  progress  of  medical  science,  and 
more  especially  upon  the  fame  of  the  Medical  School  of 
Montpellier,  should  not  be  estimated  exclusively  from  the 


296  GROWTH  OF  MEDICINE 

value  of  his  writings  nor  from  the  character  of  the  work 
which  he  performed  as  an  instructor  in  that  school.  In  the 
thirteenth  and  fourteenth  centuries  physicians  as  a  class 
did  not  hold  so  high  a  position  socially  in  Western  Europe 
as  they  were  probably  entitled  to  hold,  and  consequently 
Arnold's  later  career,  in  which  he  showed  himself  to  be  a 
wise,  broad-minded,  and  very  able  statesman  and  as  an 
enthusiastic  champion  of  greater  liberty  of  thought  in  the 
domain  of  religion,  must  be  looked  upon  as  having  aided 
very  materially  in  raising  the  profession  of  medicine 
to  a  higher  rank  and  in  adding  eclat  to  the  School  of 
Montpellier. 

Contemporaries  and  Successors  of  Arnold  of  Villanova 
at  Montpellier. — During  Arnold's  lifetime  there  does  not 
appear  to  have  been  another  physician  at  Montpellier  who 
could  be  compared  with  him  in  professional  ability  or  in 
general  culture.  There  was  one,  however,  who  attained 
considerable  fame  as  a  medical  author,  and  who  certainly 
deserves  at  least  a  brief  notice  in  this  place — Bernard  de 
Gourdon,  also  known  as  Gordonius. 

Bernard  de  Gourdon^  began  teaching  medicine  in  Mont- 
pellier in  1285  A.  D.  He  was  the  author  of  a  treatise  which 
bore  the  title  "LiZiwm  Medicinae/'  and  which  enjoyed  an 
unusual  degree  of  popularity  for  a  long  period  of  time. 
The  earliest  printed  edition  appeared  in  Lyons  in  1474  and 
was  followed  by  several  others  in  1491, 1550, 1559  and  1574. 
One  of  the  latest  editions  is  that  of  Frankfort,  1617.  The 
book  was  also  translated  into  both  French  and  Spanish. 
In  his  description  of  the  seven  parts  into  which  the  book 
is  divided,  the  author  says,  by  way  of  praising  his  own 
work:  ''In  the  lily  there  are  many  different  kinds  of 
blossoms  and  in  each  one  of  these  there  are  seven  grains 
of  a  golden  character."  The  book  treats  of  fevers,  poison- 
ings, abscesses,  tumors,  wounds  and  ulcers,  of  diseases  of 
the  liver,  spleen,  kidneys  and  bladder,  of  affections  of  the 
eyes,  and  of  numerous  other  topics.    The  work  as  a  whole, 

2  A  small  town  in  the  Department  of  Lot,  France.  The  earliest  Norman 
ancestors  of  the  Gurdon  family  in  England  are  said  to  have  derived  their 
name  from  that  of  this  town. 


ADVANCE  OF  SURGERY  297 

says  Neuburger,  lacks  depth  and  thoroughness,  and  reveals 
the  author  to  be  overfond  of  employing  drugs,  especially 
in  combination,  and  by  no  means  free  from  a  belief  in  the 
efficacy  of  amulets  and  other  supernatural  remedies.  It 
contains,  however,  one  or  two  references  to  matters  of 
historical  interest.  For  example,  in  Chapter  V.,  Part  III., 
mention  is  made  of  spectacles.  So  far  as  now  appears,  this 
is  the  first  time  that  these  useful  contrivances  are  referred 
to  in  medical  literature;  and  the  casual  manner  in  which 
the  author  speaks  of  them  suggests  the  idea  that  they  had 
already  been  known  for  some  time.  Possibly  Roger  Bacon, 
who  interested  himself  in  researches  in  the  department  of 
optics  and  who  was  a  contemporary  of  Gordonius,  may 
have  had  something  to  do  with  the  invention  of  spectacles. 
At  the  ceremony  of  the  marriage  of  the  Duchess  Juta 
of  Austria  to  Count  Louis  of  Oettingen,  at  Vienna  in  1319, 
Pietro  Buonaparte,  the  Podesta  of  Padua,  created  consid- 
erable excitement  by  wearing  a  pair  of  spectacles  which  he 
had  received  a  short  time  previously  from  Salvino  degli 
Armati  of  Florence,  the  reputed  inventor  of  these  con- 
trivances. It  is  not  generally  known  that  the  printing  of 
books  in  very  large  and  bold  type  during  the  latter  part 
of  the  fifteenth  and  the  early  part  of  the  sixteenth  centuries 
was  done  expressly  for  the  benefit  of  far-sighted  readers — 
this  defect  in  vision  characterizing  a  very  large  percentage 
of  the  learned  men  of  that  period.  The  great  number  of 
books  which,  during  those  early  days  of  the  art  of  printing, 
were  published  in  this  style,  emphasizes  the  fact  that  the 
usefulness  of  spectacles  was  not  generally  appreciated 
until  after  the  lapse  of  many  scores  of  years.  Being  very 
expensive  they  were  within  the  reach  of  only  persons  of 
wealth,  and,  in  addition,  they  were  extremely  difficult  to 
obtain.  As  late  as  during  the  year  1572,  Augustus,  Elector 
of  Saxony,  moved  by  a  strong  wish  to  possess  a  pair  of 
spectacles,  despatched  a  special  messenger  first  to  Leipzig 
and  then  to  Augsburg  with  instructions  to  purchase  them 
for  him  at  the  great  annual  fair.  This  agent,  however,  was 
unsuccessful  in  the  attempt,  and,  accordingly,  in  the 
summer  of  1574,  he  was  instructed  to  ride  on  as  far  as 


298  GROWTH  OF  MEDICINE 

Venice.  But,  on  arriving  there,  lie  was  informed  that  no 
glasses  would  be  ground  before  the  month  of  October.  He 
was  consequently  obliged  to  remain  in  that  city  until  the 
autumn,  at  which  time  he  sent  word  to  his  master  that  the 
optician's  charge  for  the  instrument  would  be  50  thalers 
(equivalent  to  $250  at  the  present  value  of  money).  The 
Elector,  it  appears,  was  only  too  glad  to  pay  this  sum  for 
the  coveted  article.  The  first  spectacles  made  were 
equipped  with  only  convex  glasses,  for  the  use  of  far- 
sighted  persons.  It  was  not  until  about  two  hundred  years 
later  that  the  art  of  grinding  concave  glasses  for  the  relief 
of  short-sighted  individuals  was  discovered. 

Guy  de  Chauliac. — After  the  lapse  of  a  few  years  there 
appeared  a  man  who  was  destined  to  add  greatly  to  the 
fame  of  the  Medical  School  of  Montpellier — not  in  the  way 
in  which  Arnold  of  Villanova  had  accomplished  this  result, 
but  by  the  publication  of  the  first  systematic  treatise  on 
surgery  which  was  written  in  Western  Europe  during  the 
Middle  Ages.  This  man  was  Guy  de  Chauliac,  about  whose 
early  life  very  little  is  known.  He  was  born  in  the  village 
of  Chauliac,  in  Auvergne,  France,  toward  the  end  of  the 
thirteenth  century,  his  parents  being  simple  peasants ;  and 
during  early  boyhood  he  probably  attended  the  school 
connected  with  the  village  church.  His  medical  studies 
were  begun  at  Toulouse  and  completed  at  Montpellier. 
But,  at  some  time  later  than  1326,  he  went  to  Bologna  and 
perfected  his  knowledge  of  anatomy  under  the  guidance 
of  Bertrucius,  Mondino  's  successor.  After  leaving  Bologna 
Guy  visited  Paris,  arriving  there  subsequently  to  the 
deaths  of  Lanfranchi,  Pitard  and  Henri  de  Mondeville. 
Although  he  remained  in  that  great  city  only  a  short  time, 
he  appears  to  have  formed  a  warm  friendship  with  several 
of  the  instructors  in  the  medical  school. 

About  the  year  1330  he  took  up  his  residence  in  Lyons. 
His  appointment  to  the  position  of  Canon  of  Saint-Just, 
a  church  which  is  located  in  that  city,  doubtless  made  it 
necessary  for  him  to  adopt  this  course.  And  yet  it  is  most 
improbable  that  he  spent  much  of  his  time  in  Lyons,  for 
his  other  duties — ^his  attendance  at  the  Papal  Court  in 


ADVANCE  OF  SURGERY  299 

Avignon,  as  private  physician  to  three  Popes  in  succession, 
and  the  numerous  calls  made  upon  him  for  professional 
advice  and  especially  for  surgical  assistance  by  people 
living  at  a  long  distance  from  Lyons — compelled  him 
repeatedly  to  absent  himself  from  his  home,  sometimes  for 
several  days  at  a  time.  In  1348  the  plague  visited  Avignon 
and  carried  off  large  numbers  of  people,  the  poet  Petrarch's 
Laura  being  one  of  the  victims.  During  that  terrible 
epidemic  Guy  was  most  faithful  in  his  devotion  to  Clement 
VI.  and  to  many  others  who  needed  his  professional  ser- 
vices. In  1357  he  was  promoted  by  Innocent  VI.  to  the 
office  of  Provost  of  Saint- Just.  In  1363  when — according 
to  his  own  declaration — he  was  an  old  man,  he  wrote  the 
treatise  on  surgery  which  has  rendered  his  name  famous 
in  the  history  of  medicine.  His  death  occurred  about 
July  23,  1368. 

Guy  was  not,  as  some  writers  have  asserted,  a  professor 
of  surgery  in  the  University  of  Montpellier ;  he  was  simply 
a  physician  who  had  won  at  that  institution  the  title  of 
** Master  in  Medicine" — the  highest  grade  conferred  by 
the  university  authorities,  and  one  which  necessarily 
implied  that  the  recipient  had  given  a  certain  number  of 
public  readings  on  medical  topics.  And  yet  in  actual 
practice  Guy  manifested  a  strong  preference  for  the  man- 
agement of  diseases  which  demanded  surgical  treatment. 
His  writings,  furthermore,  make  it  clear  that  he  had  a 
strong  affection  for  the  institution  in  which  he  had  been 
both  a  student  and  in  some  measure  an  instructor. 

The  book  which  Guy  de  Chauliac  wrote,  and  which  bears 
the  title  ^^La  Grande  Chirurgie,"  is  described  by  Mal- 
gaigne,^  one  of  the  most  distinguished  French  surgeons  of 
the  nineteenth  century,  in  the  following  terms:  **I  do  not 
hesitate  to  say  that,  with  the  single  exception  of  the  book 
written  by  Hippocrates,  there  is  not  a  work  on  surgery,  no 
matter  in  what  language  written,  which  ranks  higher  than, 
or  is  even  equal  to,  the  magnificent  treatise  of  Guy  de 
Chauliac."  Although  most  surgeons  of  the  present  day 
will   scarcely   assent   to   praise   of   such   an   extravagant 

8  Introduction  to  the  "Oeuvres  d'Ambroise  Parg,"  Paris,  1840, 


300  GROWTH  OF  MEDICINE 

nature,  they  will  undoubtedly  agree  in  according  to  this 
admirable  author  of  the  fourteenth  century  a  high  place 
of  honor  in  the  Temple  of  Fame.  Nicaise,  the  editor  of 
the  most  recent  version  of  Guy  de  Chauliac's  treatise, 
speaks  of  him  as  the  * '  founder  of  didactic  surgery. ' '  From 
1363  A.  D.,  the  date  of  its  first  publication  in  manuscript, 
to  1478,  a  period  of  more  than  one  hundred  years,  Guy's 
book  was  universally  regarded  as  the  authoritative  treatise 
on  surgery.  But  this  branch  of  medicine,  it  must  not  be 
forgotten,  was,  at  that  period  of  the  Middle  Ages,  held  in 
very  small  esteem  by  physicians  generally,  and  therefore 
it  is  almost  certain  that  Guy  received  no  encouragement 
whatever  from  any  outside  source.  All  the  greater  credit, 
therefore,  is  due  him  for  the  admirable  manner  in  which 
he  carried  on  the  task  which  he  had  set  before  himself 
during  the  last  years  of  his  life.  Extraordinary  as  it 
appears  to  us  to-day,  the  Montpellier  School  of  Medicine, 
toward  the  end  of  the  fifteenth  century  (that  is,  only  a 
comparatively  short  time  after  Guy's  death),  issued  a 
decree  that  thereafter  their  pupils  were  not  to  study  nor 
to  practice  surgery.  From  this  and  other  well-authenticated 
facts  it  appears  that  the  prejudice  which  existed  at  that 
period  among  physicians  against  surgery,  was  strong 
enough  to  render  them  blind  to  the  reality  that  it  was 
through  the  instrumentality  of  this  very  branch  of  medical 
activity  that  the  school  at  Montpellier  had  gained  such  an 
increase  in  celebrity.  They  were  unable  to  dispossess  their 
minds  of  the  idea  that  operative  and  all  other  surgical 
procedures  were  derogatory  to  the  dignity  of  the  educated 
physician. 

Guy  de  Chauliac  wrote  his  treatise  originally  in  Latin — 
not  the  Latin  of  the  classical  authors,  but  a  Latin  greatly 
deformed  by  the  introduction  of  French,  Arabic  and 
Provencal  terms — ^barbaric  Latin,  as  it  is  often  called. 
This  language  was  commonly  employed  at  the  University 
of  Montpellier  and  at  all  other  universities  at  that  period ; 
but,  as  Nicaise  states,  the  style  of  his  writing  is  so  concise, 
and  at  the  same  time  so  intelligible,  that  it  would  scarcely 
be  possible  to  translate  it  into  modern  French  without  the 


ADVANCE  OF  SURGERY  301 

loss  of  much  of  that  which  constitutes  the  charm  of  the 
book.  It  was  for  the  latter  reason  that  he  decided  to  write 
his  version  of  Guy's  treatise  in  old  French — the  French 
of  the  thirteenth  and  fourteenth  centuries.  In  order  that 
our  readers,  most  of  whom  are  doubtless  more  or  less 
familiar  with  the  finished  language  of  modern  French 
literature,  may  see  for  themselves  to  what  extent  the  latter 
differs  from  its  fourteenth  century  ancestor,  I  shall  intro- 
duce here  a  single  paragraph  of  Nicaise's  text.  I  have 
chosen  it,  more  or  less  at  random,  from  the  admirable 
chapter  which  Guy  has  written  on  wounds  in  general. 

Consequemment  playes  mortelles  non  necessairement,  ains  pour 
la  pluspart,  sont  petites  playes,  et  superficielles  es  susdites  parties, 
et  qui  penetrent  iusques  a  icelles  et  aux  chefs  des  muscles.  La 
raison  est,  parce  que  si  elles  ne  sont  bien  traitees,  il  advient  qu'on 
en  meurt :  et  si  sont  bien  traitees,  on  en  guerit :  ainsi  que  i  'ay  veu 
de  la  partie  posterieure  du  cerveau,  de  laquelle  sortit  un  peu  de 
la  substance  du  cerveau,  ce  qui  fut  reconnu  par  I'offense  de  la 
memoire,  laquelle  il  recouvra  apres  la  curation.  le  ne  dis  pas 
toutesfois  qu'on  vesquit,  s'il  en  sortoit  toute  une  cellule,  comme 
Theodore  raconte  d'un  cellier.  Aussi  Galen  ne  dit  pas,  de  deux 
blessez  qu'il  vit  guerir  en  Smyrne  du  vivant  de  son  maistre  Pelope, 
qu'il  en  fust  sorty  de  la  substance  de  cerveau,  ains  seulement  que 
le  cerveau  avoit  este  blesse:  Ne,  de  celuy  qu'il  vist  guery  en 
Smyme  (comme  il  recite  au  huitiesme  de  V Usage),  il  ne  dit  pas 
qu'il  en  sortit  de  la  substance  du  cerveau,  ains  qu'il  fust  blesse  en 
I'un  des  ventricules  gemeaux.  Et  avec  ce  on  pensoit  qu'il  fust 
guery  par  le  vouloir  de  Dieu.  Car  si  tous  deux  eussent  este  blessez, 
il  n  'eust  gueres  dure,  comme  il  dit :  et  de  ce  il  conclud  1  'utilite  de 
la  duplication  de  quelques  instruments,  ainsi  qu'a  este  dit  cy 
dessus  en  1 'anatomic.  Et  tant  de  cettui-cy,  que  de  ceux-la,  la 
guerison  rare  est  fort  rarement  faite,  comme  il  est  dit  au  com- 
mentaire  dessus  allegue. 

There  are  many  places  in  Guy's  treatise  where  his 
description  of  a  surgical  condition,  or  of  the  proper  meas- 
ures to  adopt  for  the  relief  or  cure  of  such  condition,  would 
doubtless  prove  interesting  to  our  readers,  and  would  in 
any  event  aid  them  materially  in  forming  an  independent 
judgment  as  to  the  man's  character  in  general  and  also 


302  GROWTH  OF  MEDICINE 

with  regard  to  his  qualifications  as  a  surgeon.  But  all  of 
these  descriptions,  when  rendered  in  their  entirety  into 
English,  occupy  much  space,  and  for  this  reason  I  shall 
be  obliged  to  furnish  here  merely  a  few  extracts  from  some 
of  the  more  interesting  portions  of  the  text. 

In  the  chapter  which  Guy  devotes  to  wounds  of  nerves, 
cords  and  ligaments — all  of  which  structures  were  classed 
by  him,  as  well  as  by  Galen,  as  belonging  to  the  category 
of  nerves — this  author  divides  them  into  punctured  and 
incised  wounds,  bruises  and  concussions.  As  to  the  first 
variety  he  says  that  they  may  be  divided  into  closed 
punctured  and  open  punctured  wounds. 

In  the  incised  wounds  two  kinds  may  be  distinguished :  those  in 
which  the  nerve  is  incised  in  the  direction  of  its  length  and  those 
in  which  the  cut  is  made  across  the  fibres.  A  further  subdivision 
is  practicable,  viz.,  into  wounds  accompanied  by  more  or  less 
destruction  of  the  substance  of  the  nerve  or  its  envelopes,  and  those 
in  which  such  loss  has  not  occurred.  Among  other  differences 
worthy  of  mention  are  these:  pain,  spasmodic  phenomena,  and 
abscess  formation  are  present  in  certain  cases  and  absent  in  others. 
From  all  of  which  symptoms  useful  indications  as  to  the  treatment 
needed  may  be  deduced. 

In  the  section  relating  to  the  treatment  of  such  traumatic 
affections  of  nerves,  Guy  makes  the  remark  that  the  meas- 
ures called  for  are,  for  the  most  part,  the  same  as  those 
required  for  wounds  involving  simply  the  fleshy  parts  of 
the  body. 

The  element  of  pain,  however,  is  one  of  the  factors  which  dis- 
tinguish wounds  of  a  nerve  from  ordinary  flesh  wounds,  and  it 
may  necessitate  some  slight  modification  of  the  treatment.  Aside 
from  this,  one  of  the  first  things  that  should  be  done  is  to  remove 
from  the  wound  all  foreign  substances;  after  which  the  edges  of 
the  cavity  should  be  brought  together  and  held  firmly  in  this 
position  by  appropriate  means.  Last  of  all,  care  should  be  taken 
to  protect  the  parts.  These  are  the  general  principles  which  are 
to  guide  the  surgeon's  action.  As  to  the  special  details,  they  must 
depend  upon  the  different  conditions  presented  by  each  individual 
case.  Thus,  for  example,  if  we  are  dealing  vdth  a  punctured  wound 
of  a  nerve,  there  will  be  no  edges  of  an  excavation  to  bring  together. 


ADVANCE  OF  SURGERY  303 

If  the  object  which  produced  the  puncture  is  still  lodged  in  the 
tissues,  it  must,  as  a  matter  of  course,-  be  withdrawn.  After  which, 
the  further  measures  to  be  adopted  may  be  enumerated  under  the 
following  heads:  careful  regulation  of  the  manner  of  living; 
removal  from  the  system  of  all  material  which — attracted  to  the 
wounded  part  by  the  pain — might  there  cause  irritation  or  inflam- 
mation; and  protection  of  the  body  against  any  harm  that  might 
come  to  it  through  the  occurrence  of  convulsions.  These  three 
measures  are  indicated  for  all  wounds  of  nerves.  But,  in  the  case 
of  a  punctured  wound,  still  other  procedures  should  be  employed, 
as  will  be  discussed  under  a  fourth  head. 

The  four  heads  mentioned  by  Guy  may  be  briefly  stated 
in  the  following  terms :  I.  The  patient  should  be  put  upon 
a  light  and  very  simple  diet ;  and,  in  addition,  he  should  be 
given  a  bed  that  is  soft  and  humid  {"humidus  et  mollis^ ^). 
His  surroundings  should  be  kept  quiet,  and  nothing  should 
be  permitted  to  disturb  his  peace. of  mind.  11.  To  protect 
his  tissues  from  the  injurious  influence  of  any  superfluous 
matters  of  an  irritating  nature  that  may  be  circulating  in 
the  blood  {i.e.,  cacochyme),  a  vein  on  the  opposite  side  of 
the  body  should  be  opened  and  a  certain  amount  of  this 
fluid  withdrawn.  In  certain  cases,  furthermore,  it  may  be 
well,  in  addition,  to  administer  an  aperient  remedy.  III.  If 
convulsions  develop,  the  head,  neck  and  the  entire  back 
should  be  anointed  with  well-warmed  linseed  oil  or  common 
(?  olive)  oil,  as  recommended  by  Galen.  IV.  Special 
measures  should  be  adopted  for  providing  a  free  outlet  for 
any  pus  that  may  form  in  the  deeper  parts  of  the  wound ; 
and  here  again  Galen  recommends  for  this  purpose  the 
-employment  of  one  of  several  medicinal  preparations  which 
he  enumerates.  ''But  the  more  certain  course,"  Guy  adds, 
*'is  to  make  an  opening  in  the  skin  either  with  the  razor  or 
with  the  actual  cautery  (which  latter,  according  to  Henri 
de  Mondeville,  is  the  better  plan  of  the  two),  and  then  to 
apply  some  subtle  drying  remedy  which  possesses  the  power 
to  penetrate  into  the  deepest  recesses  of  the  injured 
nerve — for  example,  savin  oil."  (Guy  has  a  good  deal 
more  to  say  on  the  subject  of  wounds  of  nerves,  but  the 
few  extracts  given  above  should  suffice. ) 


304  GROWTH  OF  MEDICINE 

It  is  now  a  well-known  fact  that  Guy  de  Chauliac  was  in 
the  habit  of  treating  fractures  of  the  thigh  by  the  employ- 
ment of  the  weight  and  pulley  as  means  of  keeping  up  a 
continuing  extension  of  the  damaged  limb.  As  his  descrip- 
tion of  the  method  in  question  is  very  brief,  it  may  not  seem 
out  of  place  to  reproduce  it  here.  Translated  into  English 
it  reads  as  follows : — 

As  to  the  plan  which  I  employ,  it  is  this :  After  making  fast  to 
the  fractured  thigh  splints  which  extend  down  as  far  as  the  feet, 
I  reinforce  the  support  which  they  give,  either  by  placing  the  limb 
in  a  box  or  by  applying  to  its  sides  bundles  of  straw  (appuye- 
ments).  [These  are  shown  in  the  left-hand  lower  comer  of  Fig. 
12.]  I  then  attach  to  the  foot  a  mass  of  lead  as  a  weight,  taking 
care  to  pass  the  cord  which  supports  the  lead  over  a  small  pulley 
in  such  a  manner  that  it  shall  pull  upon  the  leg  in  a  longitudinal 
direction.  And  if  it  then  be  found  that  there  is  not  complete 
equality  between  the  fractured  limb  and  its  fellow  as  regards 
length,  the  discrepancy  may  be  corrected  by  gently  pulling  upon 
the  former.  Every  nine  days  the  limb  should  be  cautiously 
handled;  and  at  the  end  of  about  fifty  days  it  will  be  found  that 
firm  union  has  taken  place. 

One  more  remark  seems  to  be  called  for  in  reference  to  the 
fact  that  Guy  de  Chauliac,  although  he  was  avowedly  a 
surgeon,  managed  to  win  as  great  a  reputation  and  as  high 
a  social  position  as  was  possessed  by  any  physician  of  that 
period.  The  medical  practitioner,  it  will  be  remembered, 
held  himself,  during  the  Middle  Ages,  and  was  universally 
held,  to  be  a  much  higher  type  of  man  than  the  surgeon. 
The  relative  standing  of  the  two  is  well  shown  in  the 
accompanying  sketch  (Fig.  13),  in  which  all  the  details 
(attitude,  head  gear,  gown,  etc.)  have  evidently  been  care- 
fully studied  by  the  artist.  Guy,  however,  through  the 
sheer  force  of  his  character,  and  also  probably  because  he 
was  known  to  have  won  the  highest  medical  honor  (the 
grade  of  ** Master  of  Medicine")  w^hich  it  was  in  the  power 
of  the  university  to  confer,  pushed  his  way  to  the  top,  and 
held,  for  a  period  of  twenty  years,  the  position  of  private 
physician  to  three  Popes  in  succession — Clement  VI., 
Innocent  VI.  and  Urban  V.    In  other  words,  the  prevailing 


f  patlion  gractsi  i  famltes  Isone^  tt  octro^tspau 

tuuerenoptce  eti  oteuitbttfctgutaclamnefaut  pcTtcfartfK  ocSourses/rj^tttuitJiDS 
ttaiiM  aujcbtmffaiffeats&clhofhl  Wftttit^itrtStpontlftttttntmft?  ausmcMOoniw 
irans  ocuutcs  m  rtjacfu  tiiu  continnrutmeiu  }>  font  t)cattte«  rt  ar  ompKes  e «  pertbtmt 


litres  membtfg  at  ^ttUcmit. 


.^^ 


FIG.  12.    ONE  OF  THE  WAI^DS  IN  THE  HOTEL-DIEU  OF  PARIS, 

As  it  appeared  in  the  sixteenth  century. 

(From  Chirurgie  de  Pierre  Franco,  edited  by  E.  Nicaise,  Paris,  1895.) 


ADVANCE  OF  SURGERY  305 

prejudices  and  jealousies  were  not  sufficiently  powerful  to 
block  the  triumphant  career  of  this  man  of  solid  merit  and 
high  character. 

The  State  of  Medicine  and  Surgery  in  Countries  Other 
than  Italy  and  France  During  the  Later  Portion  of  the 
Middle  Ages. — From  the  account  given  by  Neuburger  it 
appears  that  the  seeds  planted  by  the  famous  teachers  of 
medicine  and  surgery  in  Italy  and  France  during  the  thir- 
teenth and  fourteenth  centuries  had  begun  to  take  root  in 
England  and  in  the  Low  Countries  to  the  north  of  France, 
and  were  in  fact  already  producing  some  good  fruit  in  those 
lands.  Thus,  for  example,  there  have  been  handed  down 
to  our  time  the  names  of  four  physicians  who  attained  a 
certain  degree  of  eminence  in  England  during  the  thirteenth 
and  fourteenth  centuries — Gilbertus  Anglicus,  John  of 
Gaddesden,  John  Mirfeld  and  John  Arderne. 

Gilbertus  Anglicus,  who  was  the  first  English  medical 
writer  to  secure  a  certain  degree  of  celebrity  among  the 
physicians  of  continental  Europe,  wrote  a  compendium  of 
medicine  that  was  commonly  called  the  ^^Laurea  anglica.*' 
The  book  contains,  along  with  some  good  original  observa- 
tions and  the  records  of  his  own  experience,  not  a  few 
wearisome  theoretical  discussions;  and  at  the  same  time 
it  reveals  the  fact  that  the  author  was  inclined  to  favor 
remedial  measures  of  a  superstitious  nature.  In  the  last 
chapter  of  his  compendium,  however,  he  makes  the  very 
practical  suggestion  that  distillation  may  be  resorted  to 
when  one  desires  to  purify  water  that  is  contaminated. 
Gilbertus,  after  obtaining  his  preliminary  training  in  Eng- 
land in  the  early  part  of  the  thirteenth  century,  visited 
some  of  the  leading  schools  on  the  continent,  among  others 
those  of  Salerno  and  Montpellier,  in  which  latter  city  he 
appears  to  have  practiced  medicine  for  a  certain  length 
of  time. 

John  of  Gaddesden,  who  is  also  spoken  of  as  Johannes 
Anglicus,  was  born  about  1280  A.  D.  and  died  in  1361.  He 
was  therefore  a  contemporary  of  Guy  de  Chauliac.  He  is 
said  to  have  been  a  Fellow  of  Merton  College,  Oxford,  and 
to  have  held  the  positions  of  Prebendary  of  St.  Paul's, 


306  GROWTH  OF  MEDICINE 

London,  and  of  private  physician  to  the  royal  family.  He 
was  also  the  author  of  a  medical  treatise  which  was  gener- 
ally known  by  the  title,  '^Rosa  Anglica^^  (first  printed  in 
1492).  Neuburger  speaks  of  this  book  as  being  an  imitation 
of  Gourdon's  ^^Lilium  Medicinae,^^  but  of  a  somewhat 
inferior  grade,  and  he  quotes  two  or  three  passages  which 
show  that  medicine  was  in  a  very  low  stage  of  development 
in  England  at  the  beginning  of  the  fourteenth  century. 
Gaddesden,  for  example,  advises  his  confreres  to  adopt  the 
rule  of  always  securing  their  honorarium  before  they 
undertake  the  treatment  of  a  sick  person.  In  another  part 
of  the  book  he  states  that  he  treated  one  of  the  sons  of 
Edward  II.  for  small-pox  and  secured  excellent  results, 
not  merely  as  regards  the  perfect  restoration  of  his  health, 
but  also  as  regards  the  complete  prevention  of  any  pitting 
of  his  face.  He  attributes  this  success  to  the  fact  that  he 
enveloped  the  patient  in  a  red  cloth  and  took  pains  to  have 
every  object  in  the  vicinity  of  the  bed  draped  in  red.* 

John  Mirfeld,  who  lived  during  the  second  half  of  the 
fourteenth  century,  completed  his  medical  studies  in 
Oxford,  then  entered  the  Monastery  of  St.  Bartholomew's 
in  London,  and  devoted  himself  thenceforward  to  work  in 
connection  with  the  hospital  belonging  to  that  institution. 
Among  the  books  which  he  wrote  there  are  a  few  that  deal 
with  matters  of  interest  to  the  physician.  Such,  for 
example,  are  a  glossary  which  bears  the  title  ^^Synonyma 
Bartholomaei/'  a  work  called  the  ^*Breviarium  Bartholo- 

*  ' '  Gaddesden  had  for  a  long  time  been  troubled  how  to  cure  stone :  '  At 
last/  says  he,  in  his  Bosa  Anglica,  'I  thought  of  collecting  a  good  quantity 
of  those  beetles  which  in  summer  are  found  in  the  dung  of  oxen,  also  of  the 
crickets  which  sing  in  the  fields.  I  cut  off  the  heads  and  the  wings  of  the 
crickets  and  put  them  with  the  beetles  and  common  oil  into  a  pot;  I  covered 
it  and  left  it  afterwards  for  a  day  and  night  in  a  bread  oven.  I  drew  out 
the  pot  and  heated  it  at  a  moderate  fire,  I  pounded  the  whole  and  rubbed  the 
sick  parts ;  in  three  days  the  pain  had  disappeared ; '  under  the  influence  of 
the  beetles  and  the  crickets  the  stone  was  broken  into  bits.  It  was  almost 
always  thus,  by  a  sudden  illumination,  that  this  doctor  discovered  his  most 
efficacious  remedies:  Madame  Trote  [Trotula]  of  Salerno  never  confided  to 
her  agents  in  various  parts  of  the  world  the  secret  of  more  marvelous  and 
unexpected  recipes."  (From  Jusserand's  "English  Wayfaring  Life  in  the 
Middle  Ages.") 


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ADVANCE  OF  SURGERY  307 

maei/'  and  a  shorter  treatise  on  prognosis — the  ^^ Specu- 
lum.''^ None  of  these,  however,  possesses  any  special 
importance. 

John  Arderne  was  born  in  England  1307  A.  D.,  probably 
obtained  his  medical  training  in  Montpellier,  accompanied 
the  English  Army  to  France  in  the  character  of  a 
* '  Sergeant-Surgion, "  and  was  present  at  the  battle  of 
Crecy  (1346  A.  D.).  During  the  succeeding  twenty-four 
years  he  practiced  medicine  in  Wiltshire  and  Newark,  and 
then  settled  for  the  remainder  of  his  life  in  London. 
Although  his  practice  included  both  internal  diseases  and 
those  which  required  surgical  treatment,  the  great  reputa- 
tion which  he  acquired  was  based  chiefly  upon  his  success 
in  the  latter  field.  Most  of  his  writings,  it  appears,  are 
still  in  the  form  of  manuscript. .  They  deal  chiefly  with 
surgery  and  are  accompanied  by  drawings  of  the  instru- 
ments which  he  employed.  They  possess  one  feature 
which  distinguishes  them  from  the  majority  of  medical 
writings  of  the  Middle  Ages,  viz.,  they  abound  in  reports 
of  cases  observed  and  treated  by  the  author ;  and,  further- 
more, the  methods  of  treatment  which  he  recommends  are 
in  most  instances  rational  and  of  a  relatively  simple  nature. 
The  only  one  of  Arderne 's  treatises  which  has  been  printed 
is  that  relating  to  fistula  in  ano.  .  It  bears  the  title,  *' John 
Arderne — Treatises  of  Fistula  in  Ano,  Haemorrhoids,  and 
Clysters ;  from  an  early  fifteenth-century  manuscript  trans- 
lation," and  is  edited  by  D'Arcy  Power,  Early  English 
Text  Society,  Original  Series,  139;  London  and  Oxford, 
1910.  Arderne,  we  are  told  by  Neuburger,  puts  forward 
two  claims :  1,  that  he  succeeded  in  curing  a  large  number 
of  cases  of  anal  fistula,  in  proof  of  which  he  gives  the  names 
of  the  persons  upon  whom  he  operated  successfully,  many 
of  whom  are  high  up  in  the  social  scale ;  and,  2,  that  no  other 
surgeon  of  whom  he  has  any  knowledge,  either  in  England 
or  on  the  continent  of  Europe,  is  able  to  cure  the  disease. 

The  three  English  physicians  of  whom  I  have  here  given 
very  brief  accounts,  can  scarcely  be  said  to  compare 
favorably  with  those  men  who,  during  the  same  period, 
brought  fame  to  the  medical  schools  of  Bologna,  Padua, 


308  GROWTH  OF  MEDICINE 

Montpellier  and  Paris ;  and  this  fact  suggests  the  question, 
Do  these  men  really  represent  the  best  type  of  physicians 
who  lived  in  England  during  the  fourteenth  century?  The 
great  English  poet  Chaucer,  in  his  ''Canterbury  Tales" 
(written  at  about  the  same  period  of  time),  furnishes  us 
with  a  portrait  of  a  man  who  appears  to  have  been  well 
informed  with  regard  to  the  earlier  Greek  and  Arabian 
medical  authorities  as  well  as  with  the  leading  physicians 
of  his  own  time,  and  who  in  addition  was  clever  both  in 
ascertaining  the  causes  and  nature  of  his  patients '  maladies 
and  in  prescribing  for  them  the  proper  remedies.  As  this 
physician's  name  is  not  mentioned,  we  cannot  be  sure  that 
he  was  not  one  of  the  three  to  whom  reference  has  just  been 
made.  By  the  description  given  by  the  poet,  who  probably 
was  personally  acquainted  with  the  man  whose  portrait 
he  draws,  one  is  tempted  to  believe  that  he  was  a  physician 
of  a  higher  type  than  any  one  of  the  three  named  above. 
Chaucer 's  account  reads  as  follow : — 

There  was  also  a  Doctor  of  Phisik, 

In  al  this  worlde  was  ther  non  him  like 

To  speke  of  phisik  and  of  surgerye ; . 

For  he  was  grounded  in  astronomye. 

He  kepte  his  pacient  wondrously  and  we 

In  all  houres  by  his  magik  natural. 

Well  coude  he  gesse  the  ascending  of  the  star 

Wherein  his  patientes  fortunes  settled  were. 

He  knew  the  cause  of  every  maladye, 

Were  it  of  cold,  or  hete,  or  moyst,  or  drye, 

And  where  they  engendered,  and  of  what  humour ; 

He  was  a  very  parfit  practisour. 

The  cause  once  knowen  and  his  right  mesure, 

Anon  he  gaf  the  syke  man  his  cure. 

Ful  redy  hadde  he  his  apothecaries. 

To  sende  him  drugges,  and  electuaries, 

For  eche  of  them  made  the  other  for  to  wynne ; 

Their  friendshipe  was  not  newe  to  begynne. 

Wei  knew  he  the  old  Esculapius, 

And  Discorides,  and  eek  Rufus ; 

Old  Ypocras,  Haly  and  Galien ; 

Serapyon,  Razis,  and  Avycen ; 


ADVANCE  OF  SURGERY  309 

Averrois,  Damascen,  and  Constantyn ; 

Bernard,  and  Gatisden,  and  Gilbertyn. 

Of  his  diete  mesurable  was  he. 

For  it  was  of  no  superfluitee, 

But  of  gret  norishing  and  digestible. 

With  the  names  of  the  three  English  physicians  men- 
tioned above,  there  should  be  associated  that  of  Jehan 
Yperman,  who  was  born  in  Ypern,  Flanders,  during  the 
latter  half  of  the  thirteenth  century,  obtained  his  profes- 
sional training  in  Paris  under  Lanfranchi,  and  then,  in 
1303  or  1304,  accepted  the  position  of  Physician  to  the 
Hospital  of  Belle,  a  small  Flemish  town.  In  1318  he  settled 
permanently  in  Ypern,  his  native  city,  and  in  a  compara- 
tively short  time  won  completely  the  confidence  and  esteem 
of  his  fellow  townsmen  through  his  attentiveness  to  their 
wants  when  they  were  ill  and  through  the  great  skill  which 
he  manifested  in  his  work  as  a  surgeon.    He  died  1329  A.  D. 

Yperman 's  writings  deal  with  both  medical  and  surgical 
topics.  Of  those  which  have  been  translated  from  the  Latin 
into  French  are:  **La  chirurgie  de  maitre  J.  Yperman," 
Anvers,  1863;  **Traite  de  medecine  pratique  de  maitre 
J.  YpeTman,"  Anvers,  1863;  and  **Traite  de  medecine 
pratique  de  maitre  J.  Yperman,"  Anvers,  1867.  A  perusal 
of  these  works,  says  Neuburger,  easily  convinces  one  that 
Yperman  was  not  only  a  skilful  and  clever  surgeon, 
but  also  a  physician  of  independent  judgment  and  wide 
experience. 

Revival  of  the  Practice  of  Dissecting  Human  Bodies. — 
It  was  in  Italy  that  dissecting  was  carried  on  during  the 
fourteenth  century  more  vigorously  than  elsewhere  in 
Europe.  At  first  the  only  persons  who  made  such  investi- 
gations for  scientific  purposes  were  individual  physicians 
or  groups  of  physicians;  and,  in  addition,  they  were 
obliged  to  carry  on  the  work  in  a  secret  manner — that  is, 
by  stealing  from  recently  dug  graves  the  corpses  which 
were  necessary  for  such  studies.  It  is  related,  for  example, 
that  in  1319  one  of  the  teachers  in  the  Medical  School  at 
Bologna  and  four  of  his  pupils  were  brought  before  the 
Court  of  Law  under  the  charge  of  having  clandestinely 


310  GROWTH  OF  MEDICINE 

disinterred,  for  purposes  of  dissection,  the  body  of  a  man 
who  had  been  hung  for  some  crime.  At  first  the  authorities 
merely  winked  at  such  transgressions,  but  at  the  same  time 
they  made  no  attempts  to  have  the  law  against  dissecting 
annulled  or  at  least  modified.  Then,  at  a  somewhat  later 
period,  the  conviction  became  general  among  the  intelligent 
members  of  the  community  that,  unless  work  of  this  nature 
were  officially  sanctioned,  no  real  advance  in  the  knowledge 
of  human  anatomy  could  be  made,  and — what  was  probably 
of  even  greater  importance  in  their  estimation — that 
Bologna  might  at  the  same  time  lose  a  good  deal  of  its 
superiority  over  its  rivals  as  a  centre  of  learning;  and 
accordingly  it  was  found  practicable  to  grant  the  desired 
sanction  with  many  modifying  restrictions  attached.  Then, 
with  the  further  lapse  of  time,  other  medical  schools  fell 
into  line  and  secured  from  the  authorities  similar  privileges 
for  their  teachers  and  pupils.  Thus,  in  1368,  the  Senate 
of  Venice  authorized  the  medical  school  of  that  city  to  make 
a  public  dissection  of  a  human  body  once  every  year;  and, 
eight  years  later,  the  University  of  Montpellier  acquired 
the  same  privilege.  In  1391  John  I.  of  Spain  was  equally 
generous  in  his  treatment  of  the  Medical  School  at  Lerida. 
After  the  opening  of  the  fifteenth  century  no  further 
difficulties  of  a  serious  nature  were  experienced  by  the 
teachers  of  anatomy  in  procuring  at  least  some  material 
for  dissecting  purposes,  and  with  each  succeeding  year  such 
facilities  steadily  increased.  Unfortunately,  however,  there 
did  not  follow  a  corresponding  increase  in  the  knowledge 
of  human  anatomy.  As  a  matter  of  fact,  it  was  not  until 
during  the  sixteenth  century  that  any  really  valuable  work 
was  accomplished  in  this  branch  of  medicine.  Guy  de 
Chauliac,  in  the  first  chapter  of  his  treatise  {^^La  Grande 
Chirurgie^^),  gives  the  following  description  of  the  manner 
in  which  Bertrucius  taught  anatomy  in  Bologna  at  the 
beginning  of  the  fourteenth  century,  and  from  this  account 
it  is  easy  to  understand  why  the  additions  to  our  stock  of 
information  in  this  department  of  medicine  were  so  few  and 
so  unimportant  during  this  long  period.  The  so-called 
dissecting,  it  clearly  appears,  was  in  reality  a  not  very 


ADVANCE  OF  SURGERY  311 

profitable  combination  of  purely  anatomical  work  of  a 
primitive  character  and  a  search  for  evidences  of  patho- 
logical changes.  The  clinical  history  of  the  individual 
whose  body  was  undergoing  examination  does  not  seem  to 
have  played  any  part  in  the  investigation.  Here  is 
De  Chauliac's  account: — 

After  placing  the  dead  body  on  a  bench,  my  master  proceeded 
with  his  instructions,  devoting  thereto  four  separate  sittings. 
At  the  first  of  these  he  passed  in  review  those  parts  or  organs 
which  are  concerned  in  nutrition;  his  reason  for  considering  them 
first  being  that  they  are  the  earliest  to  undergo  decomposition. 
At  the  second  sitting  he  devoted  himself  to  the  spiritual  organs 
of  the  body;  at  the  third,  to  the  animal  parts;  and  at  the  fourth, 
to  the  extremities.  Following  the  example  furnished  by  Galen  in 
his  commentary  on  the  book  entitled  "The  Sects,"  he  maintained 
that  there  were  nine  things  which  should  be  taken  into  considera- 
tion when  one  examines  the  different  parts  of  the  body,  to  wit: 
their  situation ;  their  nature,  color,  bulk,  number,  and  shape ;  their 
connections  or  relations;  their  actions  and  their  utility;  and  the 
diseases  which  may  affect  them.  Conducted  in  this  manner  the 
study  of  anatomy,  he  maintained,  may  prove  helpful  to  the  physi- 
cian in  recognizing  diseases,  in  making  prognoses,  and  in  selecting 
a  suitable  plan  for  treatment. 

Puschmann,  quoting  from  Hyrtl,  says  that  Avhen  Pro- 
fessor Galeazzo  di  Santa  Sofia,  who  had  been  called  from 
Padua  to  Vienna  to  fill  the  Chair  of  Anatomy  in  the 
medical  school  of  that  city,  made  his  first  public  dissection 
of  a  human  body  (1404  A.  D.)  in  the  Biirgerspital,  the 
sittings  covered  a  period  of  eight  days ;  at  the  end  of  which 
time  he  collected  as  much  money  as  he  could  from  those 
who  had  attended  the  course,  and  turned  it  over  to  the 
treasurer  of  the  Faculty.  Then  followed  a  period  of  twelve 
years  during  which  not  a  single  public  dissection  of  a 
human  body  was  made  in  Vienna.  In  1440  the  Faculty  were 
greatly  rejoiced  over  the  prospect  of  receiving  from  the 
authorities  the  body  of  a  criminal  who  was  to  be  hung  on 
a  certain  day ;  but,  when  the  time  arrived  and  the  body  had 
actually  been  delivered  to  them,  they  were  grievously 
disappointed  by  the  sudden  coming  to  life  of  the  supposed 


312  GROWTH  OF  MEDICINE 

corpse.  Instead  of  dissecting  him  for  the  benefit  of  science, 
the  doctors  bestirred  themselves  in  the  man's  behalf, 
obtained  a  pardon  in  due  form,  and  sent  him  back  to  his 
home  in  Bavaria  under  the  escort  of  the  college  janitor. 
Not  very  long  afterward,  however,  he  committed  a  fresh 
crime,  and  this  time  was  effectively  hung.  History  does 
not  state  whether  the  dissection  then  came  off,  or  not. 

The  Medical  Faculty  of  the  University  of  Tiibingen 
established  the  rule  in  1497  that  one  human  body  should 
be  publicly  dissected  every  three  or  four  years;  it  being 
understood  that  during  the  progress  of  the  dissection  the 
professor  should  read  aloud  to  the  class  appropriate 
portions  of  Mondino's  treatise  on  anatomy.  The  instruc- 
tion in  this  department  of  medical  science  was  of  the  same 
general  character  in  all  the  other  universities  of  Germany 
at  that  period.  Anatomical  drawings,  of  a  very  crude  type, 
were  employed  as  substitutes  for  actual  dissection. 

At  Padua,  in  Northern  Italy,  the  science  of  medicine  had 
already  before  the  end  of  the  first  half  of  the  fifteenth 
century  made  a  decided  advance,  in  proof  of  which  several 
circumstances  may  be  mentioned.  In  the  first  place,  the 
importance  of  the  study  of  anatomy  had  by  this  time 
become  so  generally  recognized  that  no  special  difficulty 
appears  to  have  been  encountered  in  securing  the  erection, 
in  1446,  of  an  anatomical  theatre;  and  during  this  same 
period  several  physicians  connected  with  the  medical 
school  acquired  considerable  celebrity  by  their  publication 
of  important  treatises  on  topics  belonging  to  the  domain 
of  general  pathology  and  therapeutics,  and  by  the  wide 
influence  which  they  exerted  as  teachers.  Among  the 
number  of  those  who  helped  in  these  ways  to  spread  the 
fame  of  the  Medical  School  of  Padua  may  be  mentioned 
Hugo  Benzi,  Antonio  Cermisone,  Giovanni  Savonarola  and 
Bartolommeo  Montagnana. 

Hugo  Benzi  (or  Hugo  of  Siena)  taught  philosophy  as 
well  as  medicine  in  different  institutions  of  learning — at 
Pavia,  Piacenza,  Florence,  Bologna,  Parma,  Padua  and 
Perugia.  His  death  probably  occurred  at  Ferrara  about 
the  year  1439.    In  addition  to  commentaries  on  Hippocrates, 


ADVANCE  OF  SURGERY  313 

Galen  and  Avicenna,  he  wrote  several  practical  works 
{^^Consilia'^)  on  such  topics  as  periodical  insanity,  sto- 
machic vertigo,  naso-pharyngeal  polypi,  epilepsy,  lachrymal 
fistula,  etc. 

Antonio  Cermisone  was  a  native  of  Padua,  became  a 
teacher  of  medicine  first  in  Pavia  and  afterward  in  Padua, 
wrote  several  useful  treatises  about  various  diseases,  and 
finally  died  about  1441. 

Giovanni  Michele  Savonarola — the  grandfather  of  the 
celebrated  Girolamo  Savonarola,  who  was  burned  at  the 
stake  for  heresy  1498  A.  D. — held  the  Chair  of  Medicine 
in  Padua  from  about  1390  to  1462,  and  also  subsequently 
for  a  certain  length  of  time  in  Ferrara.  He  was  the  author 
of  a  number  of  treatises  on  practical  medical  topics — such, 
for  example,  as  fevers  (first  published  in  Venice  in  1498), 
the  art  of  preparing  simple  and  compound  aqua  vitae 
(Basel,  1597),  an  introduction  to  the  practice  of  medicine 
(1553),  the  baths  of  Italy  and  of  the  rest  of  the  world 
(Venice,  1592),  the  different  kinds  of  pulse,  etc.  (Venice, 
1497) — and  he  also  wrote  a  large  work  covering  the  entire 
field  of  medicine  and  modeled  on  the  pattern  of  Avicenna 's 
*' Canon."  The  book  is  divided  into  six  parts,  each  of 
which  is  preceded  by  an  introduction  that  is  devoted  to  the 
anatomico-physiological  bearings  of  that  particular  part; 
and  here,  in  addition,  there  are  to  be  found  scattered 
throughout  the  text  references  to  surgical  procedures. 
Among  the  references  of  this  character  the  following 
deserve  to  be  mentioned  as  worthy  of  some  notice:  the 
description  of  a  speculum  for  use  in  operations  upon  the 
interior  of  the  nose;  a  reference  to  direct  laryngoscopy; 
the  description  of  an  instrument  closely  resembling  the 
well-known  syringotome ;  the  treatment  of  curvature  of  the 
spine  by  mechanical  means,  etc.  The  book  also  reveals  the 
fact  that,  already  at  this  period  of  the  history  of  medicine 
(the  middle  of  the  fifteenth  century),  physicians  were 
beginning  to  take  a  more  active  part  than  they  had  pre- 
viously done  in  the  management  of  confinement  cases, 
which  as  a  rule  were  left  entirely  to  the  care  of  midwives. 
The  records  also  show  that  medical  men  were  interesting 


314  GROWTH  OF  MEDICINE 

themselves  more  and  more,  as  time  went  on,  in  sanitary- 
science  as  applied  to  municipal  affairs.  In  most  commu- 
nities the  need  for  such  was  indeed  most  urgent  at  that 
time.  The  reforms  of  this  nature  were  pushed  -with  special 
vigor  in  those  parts  of  Italy  which  were  governed  by  that 
enlightened  ruler  of  the  Hohenstaufen  family,  Frederic  II., 
King  of  Sicily  and  Roman  Emperor.  The  cultivation  of 
personal  hygiene  was  also  pursued  very  systematically 
during  the  later  Middle  Ages,  the  Regimen  Salernitanum 
serving  as  the  guide  in  such  matters. 

Taken  all  together  the  conditions  in  the  physician's 
world  were  in  anything  but  a  promising  state  toward  the 
end  of  the  fifteenth  century ;  but  the  dawn  of  better  times, 
of  modern  medicine,  was  near  at  hand,  and  already  signs 
of  its  approach  were  beginning  to  be  recognizable  in 
different  parts  of  Western  Europe. 


CHAPTER  XXV 

BRIEF  HISTORY  OF  THE  ALLIED  SCIENCES- 
PHARMACY,  CHEMISTRY  AND  BALNEOTHER- 
APEUTICS 

During  the  excavations  carried  on  at  the  site  of  Pompeii, 
there  were  discovered  three  houses  which  bore  every 
appearance  of  having  been  occupied  by  apothecaries. 
Among  the  objects  found  in  these  buildings  were :  A  bronze 
box  equipped  with  the  apparatus  required  for  mixing 
ointments;  a  few  surgical  instruments;  several  glass 
receptables  which  had  evidently  at  some  earlier  period 
contained  fluid  or  semi-fluid  pharmaceutical  preparations, 
but  which,  at  the  time  when  the  excavations  were  made, 
presented  merely  a  deposit  of  some  solid  but  easily  friable 
substance  at  the  bottom  of  the  vessel ;  and  quite  a  variety 
of  drugs  in  the  form  of  pills,  tablets,  powders,  etc.  At  first, 
the  impression  prevailed  that  these  must  have  been  the 
houses  of  apothecaries,  but  subsequently  the  discovery,  in 
each  instance,  of  the  house  sign  representing  a  snake  with 
a  pine  cone  in  its  mouth  (the  symbol  of  Aesculapius) 
satisfied  the  authorities  that  these  particular  buildings 
had  belonged  to  physicians.  Indeed,  as  a  matter  of  fact, 
no  good  reasons  have  thus  far  been  found  for  believing 
that  apothecaries,  in  the  modern  acceptation  of  the  term, 
existed  in  even  the  largest  cities  of  Greece  and  Italy  until 
a  much  later  date. 

Pharmacy  in  Its  Infancy. — All  through  the  Hippocratic 
period  and  during  the  years  when  Alexandria  was  at  the 
height  of  its  prosperity  as  the  great  centre  of  medical 
activity,  it  was  customary  for  the  physicians  to  prepare 
their  own  drugs.    The  same  is  true  of  the  best  physicians 


316  GROWTH  OF  MEDICINE 

belonging  to  the  Augustan  period;  they  were  not  willing 
to  put  their  trust  in  the  drugs  which  had  been  prepared  in 
the  shops  where  such  things  were  usually  sold. 

In  the  second  century  of  the  present  era  Galen  gave  the 
definition  that  a  remedial  drug,  or  '  *  Pharmakon, "  was 
something  which,  when  taken  into  the  living  body,  produces 
an  alteration  in  its  component  tissues  or  organs,  whereas 
foods  or  nutrient  elements  simply  cause  an  increase  of  the 
parts.  He  attached  great  importance  to  such  character- 
istics as  purity,  freshness,  care  in  handling,  etc.  It  was 
his  custom  to  prepare  with  his  own  hands  the  different 
combinations  of  simple  remedial  agents  which  he  admin- 
istered to  his  patients,  and  he  kept  these  combinations,  as 
well  as  the  simple  drugs  of  the  more  costly  kinds,  carefully 
stored  in  locked  wooden  boxes  in  a  room  which  was 
devoted  to  this  special  purpose  and  which  was  termed  the 
*  *  Apotheke. ' '  Originally,  therefore,  the  '  *  apothecary ' '  was 
simply  the  person  who  had  charge  of  this  room  in  which 
the  drugs  and  spices  were  carefully  ** placed  to  one  side" 
(dTTo,  rldr}^)  for  safc  keeping.  At  a  later  period,  when  the 
caretaker  became  also  the  compounder  of  drugs,  another 
word  of  a  more  comprehensive  significance — that  of 
''pharmacist" — gradually  supplanted  the  term  apothecary. 

There  is  another  word,  ''antidote,"  which  has  very 
materially  changed  its  significance  during  the  lapse  of 
centuries.  Galen,  for  example,  employed  this  word  as  a 
synonym  of  pharmakon — a  simple  remedial  agent,  and 
medical  writers  continued  using  the  term  in  this  sense 
during  the  following  thirteen  or  fourteen  centuries.  The 
word  commonly  employed,  by  mediaeval  physicians,  to 
signify  "pharmacopoeia,"  was  "  antidotarium. "  In 
modern  times  the  word  "antidote"  signifies  only  an  agent 
which  neutralizes  a  poison. 

Galen  took  a  very  great  interest  in  everything  relating 
to  the  subject  of  drugs,  and  sometimes  made  long  journeys 
for  the  purpose  of  securing  certain  plants  or  roots  which 
he  was  unable  to  procure  near  home  or  which  he  was  very 
anxious  to  obtain  in  a  more  perfect  condition  than  was 
possible  when  they  were  purchased  from  the  regular  deal- 


HISTORY  OF  THE  ALLIED  SCIENCES       317 

ers.  ** Simple  remedies,"  he  declared,  **are  pure  and 
unadulterated,  and  produce  effects  in  only  one  direction. 
It  is  the  business  of  pharmacology  to  combine  drugs  in 
such  a  manner — according  to  their  elementary  qualities  of 
heat,  cold,  moistness  and  dryness — as  shall  render  them 
effective  in  combating  or  overcoming  the  conditions  which 
exist  in  the  different  diseases. ' '  Galen 's  interest  in  pharma- 
cology materially  aided  the  advance  of  medical  science  in 
other  ways.  He  systematized  the  existing  knowledge  of 
materia  medica  and  infused  some  measure  of  orderliness 
into  the  therapeutics  of  his  day.  The  success  of  his  efforts 
in  this  direction  did  not  become  manifest  until  after  he  had 
been  dead  about  fifty  years ;  but,  if  his  ideas  were  slow  in 
meeting  with  general  acceptance,  they  took  such  deep  root 
in  the  minds  of  physicians  that  to-day  in  Persia  Galen's 
system  of  therapeutics  is  the  only  one  generally  received 
as  authoritative.  Although  the  facts  do  not  warrant  our 
making  the  same  statement  with  regard  to  Western  and 
Southern  Europe,  it  is  nevertheless  true  that  our  dispen- 
satories still  continue  to  honor  the  memory  of  this  great 
physician  by  bestowing  the  name  of  **  Galenical  Prepara- 
tions" on  a  large  group  of  pharmaceutical  combinations. 
It  is  scarcely  possible  to  state  with  any  degree  of  posi- 
tiveness  at  what  date  pharmacists,  in  the  modern  sense 
of  the  term,  came  to  be  recognized  as  constituting  a 
separate  and  honorable  class  in  every  well-organized 
community.  It  is  known,  however,  that  in  Syria  and  Persia, 
during  the  eighth  and  ninth  centuries  of  the  present  era, 
not  a  few  of  the  leading  physicians  were  the  sons  of 
apothecaries.  Honein,  for  example,  of  whose  career  I 
furnished  a  brief  sketch  in  Chapter  XIX.,  was  the  son  of 
an  apothecary;  and  the  careful  manner  in  which  he  was 
educated  during  his  youth  justifies  the  belief  that  his  father 
must  have  been  a  man  of  some  cultivation  and  not  at  all  like 
the  general  average  of  that  class  of  men  of  w^hom  Galen 
speaks  so  disparagingly.  But  even  at  that  early  period 
there  certainly  were  individuals  who  were  skilled  in  the 
pharmaceutic  art,  for  Berendes  {op.  cit.)  tells  us  that 
Dioscorides    {circa    100    A.    D.)    describes    minutely    the 


318  GROWTH  OF  MEDICINE 

manner  of  preparing  ^'Oisypum."  Oisypnm  is  identical 
with  the  modern  '  *  Lanolin  "  or  ' '  Lanolinum, ' '  and  is  a  pure 
fat  of  wool.  Mention  is  made  of  the  preparation  by  four 
different  authors  of  medical  treatises  during  the  following 
sixteen  centuries — ^viz.,  by  Aetius  in  the  sixth,  by  Paulus 
Aegineta  in  the  seventh,  by  Nicolaus  Myrepsus  in  the 
thirteenth,  and  by  Valerius  Cordus  in  the  seventeenth. 
Subsequently  to  the  latter  date  no  further  mention  of  the 
preparation  is  to  be  found  in  any  of  the  pharmacopoeias 
except  the  French  Codex  of  the  year  1758,  in  which  it  is 
classed  among  the  simple  remedies  under  the  title  of 
''Oesipe."  Finally  Liebreich,  toward  the  end  of  the  nine- 
teenth century,  brought  the  preparation  once  more  into 
favor  under  the  name  of  ''lanolin."  The  fact  that  it 
remained  in  complete  oblivion  for  such  very  long  periods 
of  time  is  easily  explained  by  the  statement  which  Berendes 
makes:  *'It  was  a  troublesome  ointment  to  manufacture, 
and  consequently  the  apothecaries  disliked  it  and  resorted 
to  all  sorts  of  falsifications. ' ' 

With  the  advance  of  the  Arab  Renaissance  pharmacy 
gradually  became  a  regular  established  occupation  in  every 
fairly  large  city  in  the  East.  It  is  known,  for  example, 
that  the  first  public  apothecary  shop  in  the  city  of  Bagdad 
was  established  during  the  eighth  century  of  the  present 
era  under  the  caliphate  of  Almansur;  and  about  the  same 
time,  probably  a  little  earlier,  there  existed  at  Djondisabour 
a  similar  pharmacy  in  connection  with  the  school  and 
hospital  of  the  Bakhtichou  family.  The  training  of  an 
apothecary  in  those  days  was  probably  the  same  as  that 
of  the  physician.  Originally  pharmacists  were  called 
' '  Szandalani, "  probably  because  they  dealt  largely  in 
sandal  wood. 

The  materia  medica  furnished  by  the  Arab  physician 
Rhazes  in  the  different  works  which  he  has  written,  is 
unusually  rich  in  simple  elements,  the  majority  of  which 
are  always  drugs  of  a  rather  mild  action;  Greece,  Persia, 
Syria,  East  India  and  Egypt  were  the  sources  from  which 
they  were  derived.  Beside  the  simple  elements,  Rhazes 
mentions  a  number  of  composite  preparations  of  drugs. 


HISTORY  OF  TEE  ALLIED  SCIENCES       319 

As  not  a  few  of  the  latter  required  very  careful  manipu- 
lation, it  may  safely  be  inferred  that  the  Arabian 
apothecaries  of  the  ninth  century  had  already  acquired 
considerable  skill  and  experience  in  their  special  field  of 
work. 

At  Salerno,  during  the  first  half  of  the  twelfth  century, 
pharmacy  began  to  assume  a  position  of  considerable 
importance.  The  work  which  was- prepared  by  Nicolaus 
Praepositus,  and  which  was  known  as  an  '  *  Antidotarium, " 
furnished  quite  full  information  with  regard  to  the  char- 
acters and  therapeutic  uses  of  nearly  150  different  drugs. 
According  to  Berendes  this  work  served  for  several  cen- 
turies as  the  basis  of  later  pharmacopoeias.  One  of  its 
notable  features  is  the  importance  which  the  author  attaches 
to  the  duty  of  weighing  very  carefully  each  of  the  drugs 
that  enter  into  the  composition  of  a  given  preparation,  of 
gathering  certain  vegetable  products  at  the  right  season, 
and  of  paying  strict  attention  to  their  quality  and  to  the 
manner  of  preserving  them. 

In  1140  A.  D.,  Roger,  King  of  Naples  and  Sicily,  pro- 
mulgated a  law  which  defined  what  should  be  the  proper 
relations  between  physicians  and  apothecaries;  and  about 
one  hundred  years  later  (1241  A.  D.)  Frederick  II. 
amplified  and  gave  greater  precision  to  this  law,  thus 
establishing  what  was  practically  an  Institute  of  Apothe- 
caries. The  following  provisions  constitute  the  essential 
features  of  the  law : — 

1.  The  physician  and  the  apothecary  shall  have  no  business 
interests  in  common. 

2.  The  physician  shall  not  himself  conduct  an  apothecary  shop. 

3.  In  each  department  of  the  kingdom  two  respectable  men, 
selected  by  the  Faculty  at  Salerno,  shall  be  assigned  the  duty  of 
furnishing  sworn  statements  to  the  effect  that  all  the  electuaries, 
syrups,  and  other  preparations  of  drugs  kept  for  sale  in  a  given 
apothecary  shop,  have  been  made  according  to  the  established 
prescriptions  and  are  offered  for  sale  only  in  that  state. 

4.  In  the  case  of  those  preparations  which  ordinarily  do  not 
keep  for  a  longer  time  than  one  year  without  spoiling,  the  price 
at  which  they  are  to  be  sold  shall  be  at  the  rate  of  3  Tarreni  (about 


320  GROWTH  OF  MEDICINE 

30  cents)  per  ounce;  while  those  which  ordinarily  remain  un- 
changed during  a  longer  period,  shall  be  valued  at  6  Tarreni  per 
ounce. 

At  the  time  which  we  are  now  considering,  it  was  not  the 
custom,  owing  largely  to  the  expensiveness  of  writing 
paper,  to  deliver  to  the  pharmacist  a  written  prescription. 
Instead,  the  physician  first  gave  his  instructions  in  person, 
and  then,  after  he  had  seen  the  mixing  and  other  steps  of 
the  apothecary's  work  properly  performed,  he  carried  the 
preparation  to  the  patient's  house. 

Long  before  the  middle  of  the  fifteenth  century  apothe- 
caries had  become  thoroughly  well  established  throughout 
Central  and  "Western  Europe.  Among  the  statutes  of  the 
Medical  Faculty  of  Erfurt,  Germany,  there  has  been  found 
one  which  dates  back  to  the  year  1412  and  which  says : — 

The  student  of  medicine,  before  he  applies  for  the  Bachelor's 
Degree,  should  spend  one  month  in  the  spring  of  the  year,  in  an 
apothecary's  establishment,  in  order  that  he  may  familiarize  him- 
self with  the  proper  manner  of  preparing  clysters,  suppositories, 
pessaries,  syrups,  electuaries  and  other  things  necessary  for  a 
physician  to  know. 

The  first  work  which  was  really  worthy  of  being  termed 
a  treatise  on  materia  medica  was  published  in  1447.  It 
bore  the  title,  "Compendium  Aromatariorum, "  and  was 
written  by  Saladin  of  Ascolo,  the  private  physician  of 
Prince  Antonio  de  Balza  Ossino  of  Tarentum.  Berendes 
says  that  it  was  a  work  of  much  practical  value. 

The  First  Indications  of  the  Beginning  of  Chemistry. — 
Up  to  a  comparatively  recent  date  it  has  been  customary 
to  speak  of  Geber  as  the  first  practical  chemist  and  the  first 
writer  among  the  ancients  who  appreciated  the  important 
part  which  chemistry  was  likely  to  take  in  medicine  and 
philosophy  at  no  distant  period  of  time.  But  to-day,  as 
appears  from  the  researches  made  by  M.  Berthelot  about 
1893,  we  are  compelled  to  abandon  the  belief  that  such  a 
person  as  Geber  existed,  and  shall  have  to  adopt  the  more 
commonplace  view  that  the  science  of  chemistry  represents 
a  gradual  development  from  the  much  older  alchemy.    We 


HISTORY  OF  THE  ALLIED  SCIENCES       321 

may  define  the  latter  branch  of  knowledge  as  the  science 
of  transforming  copper  and  brass  into  gold  and  silver. 
During  the  first  two  or  three  centuries  of  the  Christian  era 
there  existed  a  firm  belief  that  such  a  transformation  had 
actually  been  accomplished,  and  in  confirmation  of  the 
correctness  of  this  statement  it  may  be  said  that  Zosimos 
of  Panopolis,  one  of  the  leading  philosophers  of  Alexandria 
during  the  fourth  century  of  the  present  era,  and  a  man 
who  was  considered  by  his  contemporaries,  as  well  as  by 
all  later  alchemists,  to  be  perhaps  the  greatest  authority 
in  this  branch  of  knowledge,  speaks  in  unmistakable  terms 
in  his  cyclopaedic  work  on  alchemy  (28  volumes),  of  a 
certain  tincture  which  possesses  the  power  of  changing 
silver  into  gold,  and  also  of  a  ** divine  water"  or  fluid  which 
is  capable  of  effecting  many  different  transmutations. 
There  can  therefore  be  no  reasonable  doubt  that  in  the 
earlier  centuries  of  the  Middle  Ages  the  learned  men  of 
Alexandria  accepted  alchemy  as  a  well-established  agency 
of  great  power.  From  the  sixth  century  to  the  thirteenth 
this  science  was  cultivated  with  great  assiduity  by  the 
Arabs  in  the  academies  which  they  established  in  Cordova 
and  other  cities  of  Spain ;  and  it  was  from  the  latter  region 
that  the  belief  in  alchemy  spread  to  all  the  countries  of 
Western  Europe,  gradually  gaining  strength  up  to  perhaps 
the  fifteenth  century. 

It  was  during  the  thirteenth  century  that  the  so-called 
'* philosophers'  stone"  came  to  be  considered  the  most 
effective  agent  in  transmuting  the  baser  metals  into  silver 
and  gold,  and  there  were  not  a  few  who  even  believed  that 
this  as  yet  non-existent  stone  possessed  the  power  to  in- 
crease longevity,  to  confer  health,  and  to  give  a  prosperous 
issue  to  one 's  undertakings.  It  was  not  the  rabble,  but  the 
very  best  and  most  highly  educated  men  in  the  community 
who,  during  the  thirteenth  century,  took  the  most  active 
interest  in  alchemy  and  the  philosophers'  stone.  Arnold 
of  Villanova,  Raymund  Lullus,  Roger  Bacon,  Albertus 
Magnus,  and,  to  a  lesser  degree,  the  famous  theologian 
Thomas  Aquinas  were  all  believers  in  the  art  of  the  magir 
cian.    And  even  more  extraordinary  than  this  is  the  fact 


322  GROWTH  OF  MEDICINE 

that  in  Germany  men  of  this  stamp  continued  for  two  or 
three  centuries  longer  to  cherish  a  belief  in  the  reality  of 
alchemistic  processes.  Even  Martin  Luther  (1483-1546), 
the  great  reformer,  did  not  hesitate  to  express  his  approval 
of  '^the  black  art,"  as  is  shown  by  the  following  quotation 
from  one  of  his  writings: — 

The  art  of  alchemy  is  commendable  and  belongs  in  truth  to  the 
philosophy  of  the  ancient  wise  men,  a  fact  which  pleases  me  greatly, 
not  merely  because  of  the  intrinsic  merits  and  usefulness  of  the 
art  in  the  matter  of  distillations  of  vegetables  and  oily  fluids  and 
sublimation  of  metals,  but  also  because  it  serves  as  such  a  noble 
and  beautiful  symbol  of  the  resurrection  of  the  dead  at  the  last 
day  of  judgment.     (Berendes.) 

Another  celebrated  character  who  dabbled  in  the  black 
art  was  Johannes  Faust,  who  was  born  in  1485,  obtained 
his  degree  of  Bachelor  of  Arts  at  the  University  of  Heidel- 
berg, and  died  in  1540  in  Staufen  in  Breisgau.  Professor 
Scherer  of  Berlin  says  that  *'he  was  a  great  braggart, 
never  failed  to  create  a  sensation  wherever  he  went,  and 
had  the  conceit  and  effrontery  to  pass  himself  off  as  a 
scientist  among  the  learned  men  of  his  day.  He  called 
himself  the  philosopher  of  philosophers,  a  second  Magus. 
He  maintained  that  he  was  both  a  physician  and  an 
astrologer,  and  claimed  that  he  could  restore  the  dead  to 
life,  and  could  predict  future  events  from  a  mere  inspection 
of  fire,  air  and  water." 

But  although  the  persistent  and  wonderfully  energetic 
activities  of  the  alchemists  failed  to  find  the  philosophers* 
stone,  or  to  transmute  the  baser  metals  into  silver  and  gold, 
they  placed  in  the  hands  of  man  the  key  to  a  knowledge 
of  chemistry,  that  branch  of  science  which  was  destined 
in  later  years  to  play  such  an  important  part  in  pharmacy, 
in  agriculture  and  in  other  industries.  Thus  we  owe  to 
alchemists  the  discovery  of  many  processes  and  the  inven- 
tion of  many  apparatus  which  serve  as  the  groundwork 
of  modern  chemistry.  Some  of  the  more  important  of 
these  are  the  following:  The  use  of  the  spirit  lamp;  the 
invention  of  tubular  retorts ;  the  production  of  potash  and 


HISTORY  OF  TEE  ALLIED  SCIENCES       323 

soda  by  burning  the  hard  deposit  which  collects  in  wine 
casks  as  well  as  various  marine  plants;  the  oxidizing  of 
certain  metals  (iron,  lead,  copper,  quicksilver  and  anti- 
mony) ;  the  making  of  metallic  arsenic,  of  wine  of  anti- 
mony, of  sulphate  of  iron,  of  chloride  of  silver,  of  acetic 
acid  and  of  many  other  chemical  products ;  the  purification 
of  metals  by  the  use  of  lead,  etc. 

Supplementary  Data  Relating  to  Balneotherapeutics. — I 
have  referred  to  this  subject  on  several  occasions  in  the 
course  of  the  earlier  chapters  of  this  history,  but  always 
without  entering  very  much  into  details.  This  policy  was 
adopted,  partly  because  the  facts  upon  which  a  satisfactory 
sketch  of  the  growth  of  balneotherapeutics  might  be  based 
were  not  very  numerous,  and  partly  because  of  the  neces- 
sity of  gaining  space  for  more  important  matters. 

The  principal  facts  to  which  I  made  reference  were: 
First,  that  before  the  Christian  era  the  employment  of 
baths  in  a  variety  of  different  ways  for  therapeutic  pur- 
poses was  universal  in  the  East;  and,  second,  that  in  the 
city  of  Rome  during  the  centuries  immediately  following 
the  birth  of  Christ,  facilities  for  this  kind  of  treatment 
were  provided  on  a  most  lavish  scale — as  in  the  baths  of 
Agrippa  (27  A.  D.),  of  Titus  (79  A.  D.),  of  Caracalla 
(211  A.  D.),  and  of  Diocletian  (302  A.  D.).  I  may  now  add 
that  the  warm  springs  of  Aachen  (Aix-la-Chapelle),  Baden- 
Baden  and  Wiesbaden,  in  Central  Europe,  and  Bath,  in 
England,  were  known  to  the  ancient  Romans,  and  were 
utilized  by  them  to  some  extent  for  therapeutic  purposes ; 
but  it  was  not  until  a  much  later  period  that  they  and  the 
less  well-known  springs  of  Schwalbach,  Driburg,  Warm- 
brunn,  Goeppingen  and  Gastein  began  to  be  actively 
frequented  for  remedial  purposes.  By  the  beginning  of 
the  sixteenth  century  it  had  become  a  very  popular  thing 
for  sufferers  from  all  sorts  of  ailments  to  resort  to  these 
and  other  European  springs.  The  history  of  the  thera- 
peutic employment  of  mineral  waters  belongs,  however,  to 
the  period  of  modern  medicine  rather  than  to  that  which 
I  have  been  considering  in  the  present  volume. 


PART  III 
MEDICINE  DURING  THE  RENAISSANCE 


CHAPTER  XXVI 

IMPORTANT  EVENTS  THAT  PRECEDED  THE 
RENAISSANCE— EARLY  ATTEMPTS  TO  DIS- 
SECT THE  HUMAN  BODY 

Important  Events  Immediately  Preceding  the  Renais- 
sance.— Three  hundred  years  before  the  Christian  era 
Erasistratus  and  Herophilus  made,  at  Alexandria,  Egypt, 
an  attempt  to  develop  a  correct  knowledge  of  anatomy  by 
means  of  dissections  of  human  corpses,  but  the  political 
and  religious  conditions  at  that  time  were  not  favorable 
to  scientific  work,  and  therefore  the  success  attained  was 
of  a  very  restricted  character.  Then,  during  the  succeeding 
three  or  four  centuries,  this  early  movement  gradually  died 
out,  and  no  further  contributions  to  our  knowledge  of 
human  anatomy  were  made  until  toward  the  end  of  the 
second  century  of  the  present  era,  at  which  time  Claudius 
Galen,  a  man  of  giant  intellect  and  tireless  energy,  did  his 
best  to  supply  the  anatomical  knowledge  so  urgently 
needed.  But  the  deeply  rooted  prejudices  of  that  age 
against  dissections  of  the  human  body  lay  like  an  insur- 
mountable barrier  across  his  path  and  forced  him  to  confine 
his  efforts  to  the  dissection  of  those  animals  whose  bodily 
construction  resembled  more  or  less  closely  that  of  man. 
Galen  believed  that  the  anatomy  which  he  thus  evolved 
for  the  guidance  of  his  professional  brethren  would  satisfy 
all  their  legitimate  wants  of  this  nature,  and  he  proceeded 
to  build  upon  this  faulty  and  unstable  foundation  an  equally 
faulty  physiology.  History  records  the  extraordinary  fact 
that  Galen's  belief  in  the  sufficiency  of  his  anatomy  and 
physiology  for  all  the  reasonable  needs  of  physicians  and 
surgeons  was  so  well  grounded  that  during  the  following 


328  GROWTH  OF  MEDICINE 

thirteen  or  fourteen  centuries  nobody  dared  to  cast  the 
slightest  suspicion  upon  the  trustworthiness  of  these 
foundations  of  the  science  of  medicine.  Then  followed, 
during  the  fourteenth  and  fifteenth  centuries,  an  awakening 
which  seemed  to  affect  all  departments  of  human  activity. 
This  movement,  which  is  commonly  termed  the  ''Renais- 
sance, ' '  developed  at  first  very  slowly,  and  reached  a  note- 
worthy degree  of  momentum  only  toward  the  middle  of  the 
fifteenth  century,  about  which  time  there  occurred  several 
events  that  contributed  greatly  to  strengthen  and  per- 
petuate the  movement.  Such  were,  for  example,  the 
employment  of  gunpowder  in  the  wars  of  Western  Europe ; 
the  invention  of  a  method  of  manufacturing  paper — a 
discovery  which  led  to  the  abandonment  of  the  much  more 
expensive  parchment,  and  prepared  the  way  for  the 
invention  of  printing  in  its  different  forms;  the  taking 
of  Constantinople  by  the  Turks  in  1453;  the  discovery  of 
America  in  1492 ;  and,  finally,  the  Reformation  inaugurated 
by  Martin  Luther.  Let  us  pass  in  review  very  briefly  each 
of  these  events,  in  order  that  we  may  the  better  appreciate 
how  the  science  of  medicine,  in  the  short  space  of  time 
represented  by  a  couple  of  centuries,  made  a  greater 
advance  than  it  had  previously  made  in  the  course  of 
several  hundred  years. 

The  employment  of  gunpowder  in  warfare  robbed  the 
knight  of  the  protection  which  he  had  previously  enjoyed 
from  the  wearing  of  metal  armor,  and  thenceforward  his 
life  was  as  much  imperiled  in  battle  as  was  that  of  the  foot- 
soldier,  who  was  not  permitted  to  protect  his  person  in  this 
manner.  Thus  were  the  two  upper  classes  of  the  commu- 
nity, the  nobles  and  the  bourgeois,  in  any  conflict  which 
might  arise  between  them,  placed  more  nearly  upon  a 
footing  of  equality.  The  ultimate  result  showed  itself  in 
an  increased  importance,  an  increased  prosperity,  of  the 
middle  class  or  bourgeoisie,  from  which  the  physicians 
chiefly  came.  Indeed,  feudalism  from  this  time  forward 
rapidly  ceased  to  exist. 

The  discovery  of  paper,  an  excellent  and  relatively  cheap 
substitute  for  parchment,  facilitated  wonderfully  the  spread 


EVENTS  PRECEDING  THE  RENAISSANCE   329 

of  knowledge.  Parchment,  the  material  upon  which  books 
were  written,  was  expensive  and  was  at  times  difficult  to 
obtain;  both  of  which  circumstances  rendered  books  so 
costly  that  only  a  few  physicians  were  able  to  become  the 
owners  of  the  important  standard  medical  works  of  that 
period — such,  for  example,  as  the  Hippocratic  writings, 
Galen's  treatises,  the  surgical  manuals  of  de  Mondeville 
and  Guy  de  Chauliac,  the  pharmacopoeia  of  Dioscorides, 
and  still  other  books  of  lesser  value.  And,  if  a  satisfactory 
method  of  manufacturing  paper  had  not  first  been  dis- 
covered, the  benefits  growing  out  of  the  invention  of 
printing  in  1467  would  have  been  far  less  than  they  actually 
proved  to  be.  Some  idea  of  the  magnitude  of  these  benefits 
may  be  formed  from  the  following  statement  of  facts.  The 
demand  for  books,  after  the  invention  of  printing,  became 
so  great  that  the  presses  were  kept  almost  constantly  busy. 
At  first,  according  to  the  record  furnished  by  Haeser, 
Venice  and  Rome  took  the  lead  in  supplying  this  great 
demand  for  books;  the  former  city  printing  2978  and  the 
latter  972  volumes  between  the  years  1467  and  1560;  but, 
during  a  later  period  (1500-1536),  Paris  outstripped  Venice 
with  a  total  of  3056  volumes,  and  Strassburg  advanced  to 
the  second  place  with  a  showing  of  1021  volumes  printed 
during  the  same  period  of  time.  Thanks  to  the  great 
diminution  in  the  market  price  of  books  that  resulted  from 
the  two  inventions  named — the  manufacture  of  paper  and 
the  introduction  of  printing — almost  every  physician  in 
fairly  prosperous  circumstances  was  able  at  that  period 
to  purchase  the  relatively  few  medical  treatises  which 
issued  from  the  presses;  and,  besides,  new  authors  were 
thenceforth  stimulated  to  put  their  experiences  into  print. 
Among  the  very  first  medical  books  printed  the  following 
deserve  to  be  mentioned: — 

(In  Germany.)  Buck  der  Biindth-Erznei,  by  Heinrich  von 
Volsprundt,  1460. — Das  huch  der  wund  Artzeny.  Handwirckung 
der  Cirurgia  von  Jyeronimo  hrunschwick,  1508. — Das  Feldtbuch 
der  Wundtartzney,  by  Hans  von  Gerssdorff,  1517. 

(In  Italy.)  Avicennae  opera,  arabice,  1473. — Guillelmi  de 
Saliceto  cyrurgia,  1475.     (A  French  translation  was  published  at 


330  GROWTH  OF  MEDICINE 

Lyons  in  1492.) — Celsi  de  medicina  liber,  etc.,  1478. — Guidonis  de 
Cauliaco  cyrurgia,  1490.  (A  French  version  was  printed  in  Lyons 
in  1498.) 

(In  France.)  Christophori  de  Barzizus  de  fehrihum  cognitione 
et  cura,  1^94:.— Bernard  de  Gourdon,  traduction  de  son  "Lilium 
medicinae,"  1495. 

When  Constantinople  fell  into  the  hands  of  the  Turks 
in  1453,  many  of  its  Greek  inhabitants,  and  particularly 
those  belonging  to  the  more  highly  educated  classes,  fled 
to  Western  Europe  in  order  to  escape  from  the  tyranny 
of  the  invaders.  Not  a  few  of  these  refugees  brought  with 
them  to  Italy  and  France  copies  of  the  works  of  the  classical 
Greek  authors,  and  on  this  account,  as  well  as  because  of 
their  willingness  to  give  instruction  in  their  native  tongue, 
they  met  with  a  cordial  welcome  wherever  they  took  up 
their  new  abodes.  Their  arrival  in  Italy  happened  at  a 
most  propitious  time,  for  the  interest  in  Greek  literature 
was  at  that  period  just  beginning  to  develop  among  Italian 
scholars.  Previously,  Greek  had  been  an  almost  unknown 
tongue  in  Italy.  Petrarch,  for  example,  is  reported  to 
have  said  in  1360  that  he  did  not  know  of  ten  educated  men 
in  that  country  who  understood  Greek;  and  there  is  no 
evidence  to  show  that  the  number  of  such  men  increased 
between  1360  and  the  time  when  the  refugees  from  Constan- 
tinople arrived.  Many  of  the  works  of  greatest  importance 
to  physicians — such,  for  example,  as  the  writings  of 
Hippocrates,  of  Galen,  of  Rufus  of  Ephesus,  of  Oribasius, 
of  Alexander  of  Tralles,  and  of  several  other  classical 
medical  authors  of  antiquity — were  accessible  (in  the 
original)  only  to  those  who  were  familiar  with  the  Greek 
tongue.  Consequently  the  arrival  of  these  refugees  from 
Constantinople  constituted  a  most  important  event  in  the 
history  of  European  medicine. 

The  discovery  of  America  by  Christopher  Columbus  in 
1492  owed  its  origin  in  part  to  the  restless  spirit  of 
adventure  which  was  abroad  in  Spain  and  Italy  at  that 
time,  and  also,  in  perhaps  still  larger  measure,  to  the  hope 
of  gain  which  might  be  expected  to  follow  the  discovery  of 
a  shorter  and  more  direct  route  to  India.    As  regards  the 


EVENTS  PRECEDING  THE  RENAISSANCE  331 

attainment  of  the  latter  object,  the  great  explorer  failed, 
but  his  discovery  of  a  new  continent  resulted  eventually  in 
bringing  great  wealth  to  the  rulers  of  Spain,  in  stimulating 
maritime  commerce,  and  in  broadening  men's  views  with 
regard  to  every  phase  of  human  activity.  The  addition 
of  a  few  new  drugs  to  the  pharmacopoeia  was  a  further 
result  of  some  importance.  Luther's  efforts  to  reform  the 
government  and  doctrines  of  the  Church  undoubtedly  gave 
a  great  impetus  to  the  Renaissance  and  therefore  to  the 
growth  of  the  science  of  medicine.  Men  learned  to  use 
their  reasoning  powers  with  greater  freedom,  and  as  a 
result  our  knowledge  of  the  structure  of  the  human  body 
(anatomy)  and  of  the  working  of  its  complicated  machin- 
ery, both  in  health  (physiology)  and  in  disease  (pathology), 
made  astounding  advances.  And  it  is  to  the  consideration 
of  these  fundamental  branches  of  medical  knowledge  that 
we  must  now  turn  our  attention. 

Early  Attempts  to  Dissect  the  Human  Body. — Already 
as  early  as  during  the  first  half  of  the  fourteenth  century 
physicians  began  to  appreciate  the  fact  that  further 
progress  in  the  knowledge  of  medicine  was  not  to  be 
attained  otherwise  than  by  a  more  profound  study  of  human 
anatomy  than  had  been  made  up  to  that  time;  and  they 
realized  that  it  was  only  by  means  of  actual  dissections  that 
this  more  profound  study  might  be  made.  Various  in- 
fluences, however,  co-operated  to  hinder  such  study.  In 
the  first  place,  the  people  at  large  were  thoroughly  imbued 
with  the  idea  that  dissecting  a  human  corpse  was  an  act  of 
desecration,  and  consequently  it  was  by  no  means  safe  for 
a  physician  to  do  any  work  of  this  character  except  in  the 
most  secret  manner.  Then,  in  addition,  it  was  commonly 
believed — and  this  belief  persisted  even  up  to  a  compara- 
tively recent  date — that  the  bull  which  Pope  Boniface  VIII. 
issued  in  1300 — and  which  declared  that  whoever  dared  to 
cut  up  a  human  body  or  to  boil  it,  would  fall  under  the  ban 
of  the  church — ^was  intended  to  cover  dissections  for  pur- 
poses of  anatomical  study.  The  recent  investigations  of 
Corradi,  however,  show  (Haeser,  p.  736  of  the  third 
edition)  that  this  bull  was  not  intended  to  apply  to  dissec- 


332  GROWTH  OF  MEDICINE 

tions  for  scientific  purposes,  but  simply  to  put  an  end  to 
the  practice  of  cutting  up  human  corpses  and  boiling  the 
separate  sections  in  order  to  obtain  the  bony  framework 
in  a  condition  suitable  for  transportation  from  Palestine 
to  Europe, — a  practice  which  had  grown  to  be  very  common 
among  the  Crusaders. 

Mondinus'  ''Anatomy,"  which  was  published  in  1314, 
reveals  the  fact  that,  during  the  early  part  of  the  fourteenth 
century,  several  private  dissections  were  made.  As  might 
be  expected,  from  the  primitive  character  of  the  illustrations 
that  accompany  the  text  of  Mondinus'  work,  these  dis- 
sections were  carried  out  in  a  very  imperfect  manner,  for — 
to  mention  only  a  single  example — this  author  admits  that 
he  made  no  attempt  to  investigate  the  deeper  structures 
of  the  ear,  as  such  an  examination  would  necessitate  the 
employment  of  violent  measures,  ' '  which  would  be  a  sinful 
act." 

The  archives  of  the  Bolognese  School  of  Medicine  con- 
tain an  item  which  reveals  the  active  interest  taken  in 
anatomy  by  the  students  of  that  day.  It  reads  as  follows : 
''At  Bologna,  in  1319,  several  of  the  Masters  stole  from 
a  grave  the  corpse  of  a  woman  who  had  been  buried  two 
days  before,  and  then  turned  it  over  to  Master  Albertus 
to  dissect  in  the  presence  of  a  large  number  of  students." 
At  the  Medical  School  of  Montpellier,  in  the  south  of 
France,  the  Faculty  obtained  permission  in  1376  to  dissect 
the  corpse  of  an  executed  criminal  once  every  year;  and 
the  records  show  that  the  school  actually  availed  itself  of 
this  privilege  in  the  years  1377,  1396  and  1446.  Felix 
Platter,  who  afterward  became  one  of  the  most  distin- 
guished physicians  of  Basel,  Switzerland,  pursued  his  early 
medical  studies  at  the  latter  university  during  the  years 
1552-1557 ;  and,  in  the  diary  which  he  faithfully  kept  during 
this  period,  he  reveals  in  an  interesting  manner  what 
difficulties  as  well  as  dangers  he  experienced,  first,  in 
reaching  Montpellier  from  his  home  in  the  eastern  part  of 
Switzerland,  and,  second,  in  obtaining  greater  opportuni- 
ties for  acquiring  a  genuine  knowledge  of  anatomy  than 
the  school  itself  afforded  in  its  official  course.    Although, 


EVENTS  PRECEDING  THE  RENAISSANCE   333 

owing  to  lack  of  space,  I  shall  not  be  able  to  quote  in  full 
the  appropriate  portions  of  this  most  interesting  narrative, 
I  will  furnish  an  abridged  English  translation  of  the  story 
as  it  appears  in  Platter's  journal  or  diary.  In  all  its  more 
important  details  the  account  reads  as  follows ; — 

Our  little  party  was  composed  of  three  persons,  viz.,  Thomas 
Schoepfius,  the  schoolmaster  of  St.  Pierre ;  a  Parisian  by  the  name 
of  Robert  who  happened  to  be  passing  then  through  Basel  on  his 
way  to  Geneva;  and  myself,  a  lad  of  sixteen.  We  traveled  on 
horseback  and  all  three  of  us  were  armed  with  rapiers.  My  outfit, 
which  was  handed  to  me  by  my  father  shortly  before  our  departure, 
consisted  of  two  extra  shirts  and  a  few  pocket-handkerchiefs, 
wrapped  up  in  a  piece  of  waxed  cloth.  In  the  matter  of  funds  for 
the  journey  I  received  from  my  father  three  crowns  in  silver  and 
four  gold  pieces  which,  for  further  security,  he  sewed  into  my  vest. 
In  addition,  he  presented  me  with  a  rare  piece  of  silver  money 
which  had  been  issued  by  the  Cardinal  Mathieu  Schiner,  of  the 
Canton  de  Valais,  who  personally  commanded  the  Swiss  soldiers 
in  their  successful  combat  with  the  troops  of  Louis  the  Twelfth,  at 
Marignan.  It  was  a  coin,  therefore,  which  possessed  considerable 
historical  value.  My  mother  also  bestowed  upon  me  a  gold  coin 
(a  couronne).  As  a  last  injunction  my  father  begged  me  not  to 
forget  that,  in  order  to  procure  the  money  which  he  had  just  placed 
in  my  hands,  as  well  as  that  which  he  had  already  paid  for  my 
horse,  he  had  been  obliged  to  mortgage  his  property. 

We  left  the  city  at  nine  o  'clock  on  the  morning  of  Oct.  10th,  1552, 
and  at  the  same  moment  the  news  reached  us  that  the  Plague  had 
made  its  appearance  in  Basel.  This  was  a  most  depressing  piece 
of  intelligence,  especially  as  we  were  already  in  great  fear  that  the 
army  of  the  Emperor  Charles  the  Fifth,  which  was  at  that  time 
on  its  way  to  the  siege  of  Metz,  would  utterly  destroy  our  city. 

We  arrived  at  Berne  early  on  the  morning  of  Oct.  12th,  and, 
after  leaving  our  horses  at  the  inn,  The  Falcon,  lost  no  time  in 
visiting  the  objects  of  interest  in  that  ancient  city,  not  forgetting 
the  bear  pit,  in  which  there  were  at  that  time  six  of  these  creatures. 
In  the  afternoon  we  resumed  our  journey  toward  Fribourg,  and 
very  soon  overtook  a  newly  married  couple.  As  they  were  traveling 
on  horseback  like  ourselves,  and  were  following  the  same  route 
for  a  certain  distance,  we  all  agreed  to  keep  together.  While 
passing  along  a  shady  part  of  the  road  the  bride's  dress  became 
so  firmly  entangled  in  the  branches  of  an  apple  tree  that,  failing 


334  GROWTH  OF  MEDICINE 

to  stop  the  horse,  she  was  left  suspended  in  the  air  by  her  skirts. 
I  immediately  dismounted  and  helped  her  to  regain  her  feet,  to 
adjust  her  disordered  dress,  and  to  resume  her  seat  in  the  saddle. 
On  arriving  at  Fribourg  we  put  up  at  the  inn  called  La  Croix 
Blanche,  and  soon  discovered  that  almost  everybody  in  the  town 
spoke  French,  a  language  with  which  Thomas  and  I,  who  were 
Germans,  were  not  familiar ;  but,  thanks  to  our  companion  Robert, 
the  Parisian,  we  experienced  no  difficulty  whatever  in  making  all 
our  wants  known  and  in  securing  all  the  information  that  we 
desired. 

On  the  following  day,  Oct.  13th,  it  was  raining  hard  when  we 
left  Fribourg,  and  we  were  soon  wet  to  the  skin.  After  passing 
through  several  small  villages  we  stopped  for  refreshment  at  an 
inn  in  the  picturesque  town  of  Romont,  and  at  the  same  time 
availed  ourselves  of  the  opportunity  to  have  our  clothes  dried. 
Then,  having  satisfied  our  appetites,  we  resumed  our  journey  in 
the  direction  of  Lausanne ;  but  we  did  not  get  very  far  on  our  way 
before  we  discovered  that  Thomas  had  disappeared.  "We  were  of 
course  obliged  to  wait  for  him,  and,  by  the  time  he  had  rejoined 
the  party,  darkness  and  a  thick  fog  combined  to  render  further 
progress  very  difficult,  and  we  soon  realized  that  we  had  lost  our 
way.  We  wandered  up  and  down  for  some  time  without  encounter- 
ing a  barn  or  building  of  any  kind  in  which  we  might  find  shelter 
from  the  rain  and  secure  a  measure  of  protection  from  the  robbers 
who,  according  to  common  report,  infested  that  part  of  the 
country.  Finally,  however,  we  discovered  a  small  village;  but, 
when  we  applied  for  a  night 's  lodging,  not  one  of  the  householders 
was  willing  to  receive  us.  So  we  engaged  the  services  of  a  young 
peasant  to  act  as  our  guide,  and  with  his  assistance  we  finally 
reached  a  mean-looking  inn  in  a  village  called  Mezieres,  which  was 
composed  of  a  few  widely  scattered  houses.  We  entered  the  tavern 
and  found  several  Savoyard  peasants  and  some  beggars  seated  at 
the  long  table  of  the  bar-room;  they  were  engaged  in  eating  roasted 
chestnuts  and  black  bread,  which  they  washed  down  with  copious 
draughts  of  a  liquor  called  piquette.  They  unceremoniously 
examined  our  weapons  and  acted  with  great  rudeness  toward  us 
in  other  respects.  The  woman  who  kept  the  house  said  she  had  no 
other  room  which  she  could  place  at  our  disposal,  and  our  first 
impulse  therefore  was  to  resume  our  journey  immediately  after 
we  had  finished  our  meal  of  black  bread  and  chestnuts;  but,  after 
careful  reflection,  we  came  to  the  conclusion  that  such  a  course 
might  prove  fraught  with  considerable  danger.     So  we  decided  to 


EVENTS  PRECEDING  THE  RENAISSANCE   335 

remain  awake  and  watch  for  an  opportunity  to  make  our  escape. 
Very  soon  afterward  these  half-intoxicated  men  lay  down  on  the 
floor  before  the  fire  in  the  adjoining  hall- way  or  vestibule  and  fell 
into  a  sound  sleep.  Our  guide  then  confessed  to  us  that,  while  at 
work  in  the  stable,  he  had  heard  them  planning  to  waylay  us  on 
the  highway  at  an  early  hour  of  the  following  day.  As  soon, 
therefore,  as,  we  heard  them  all  snoring  lustily  we  very  quietly 
slipped  out  of  the  house.  Our  score  having  already  been  paid 
earlier  in  the  evening,  and  our  horses  having  been  left  saddled  and 
bridled  in  the  stable,  we  mounted  and  took  our  departure  by  a  road 
which  led  at  first  in  a  direction  different  from  that  in  which  we 
were  supposed  to  be  traveling.  We  experienced  no  further  trouble 
on  this  part  of  our  journey  and  in  due  time  reached  Lausanne. 
When  we  told  the  people  at  the  inn  about  our  experience  at 
Mezieres  they  replied  that  we  might  consider  ourselves  most  fortu- 
nate, as  almost  every  day  there  occurred,  in  the  forest  through 
which  we  had  passed  {la  For  it  du  Jorat),  a  murder  or  some  other 
deed  of  violence.^  It  was  plain,  therefore,  that  we  had  had  a  narrow 
escape  from  death. 

In  the  further  course  of  our  journey  along  the  north  shore  of 
the  lake  we  reached  the  city  of  Geneva  on  Oct.  15th.  When  I  called 
upon  John  Calvin,  to  whom  my  father  had  given  me  a  letter  of 
introduction,  he  said  to  me:  "My  Felix,  you  arrive  at  the  right 
moment,  for  I  am  now  able  to  give  you  an  excellent  traveling 
companion  for  the  remainder  of  your  journey — to  wit,  Dr.  Michel 
Heronard,  a  native  of  Montpellier. "  This  Dr.  Heronard,  as  I 
learned  subsequently,  was  a  Protestant  who  played  a  prominent 
part  in  the  religious  disorders  which,  a  few  years  later,  greatly 
disturbed  the  peace  of  that  city 

On  the  30th  of  October — just  twenty  days  after  we  set  out  from 
Basel — we  entered  the  city  of  Montpellier,  and  I  lost  no  time  in 
hunting  up  Laurent  Catalan,  the  apothecary,  at  whose  house  I 
expected  to  reside  during  my  stay  in  that  city. 

Platter  had  now,  after  a  long  and  dangerous  journey, 
reached  one  of  the  three  greatest  medical  schools  of  that 

1  Some  weeks  later  our  fellow  voyager,  Thomas  Schoepfius,  wrote  to  me  that, 
on  the  return  journey,  he  learned  at  Berne  that  "Long  Peter,"  the  leader  of 
the  MeziSres  robbers,  had  been  apprehended  by  the  authorities  and  executed 
for  his  crimes;  and  that,  when  stretched  on  the  rack,  he  had  confessed,  among 
other  things,  that  he  had  tried  to  murder  and  rob  some  students  who  passed 
through  M6zi6res  on  their  way  to  Lausanne. 


336  GROWTH  OF  MEDICINE 

period,  and  it  was  his  hope  and  expectation  that  he  would 
here  be  able  to  acquire  a  correct  and  intimate  knowledge 
of  human  anatomy.  He  was  already  aware  that  this 
knowledge  could  be  satisfactorily  obtained  in  only  one 
way — that  is,  by  dissecting  the  human  body;  and  accord- 
ingly he  availed  himself  of  every  possible  opportunity, 
during  the  five  years  which  he  spent  at  Montpellier,  to 
accomplish  this  purpose.  From  the  somewhat  superficial 
examination  which  I  have  made  of  the  record  furnished 
by  the  diary,  it  appears  that  only  five  or  six  official  lessons 
or  demonstrations  were  given  by  the  professor  of  anatomy 
during  the  period  of  time  named;  but — as  every  student 
of  medicine  knows — instruction  of  this  character  is  of 
relatively  small  value;  and  Platter  himself  seems  to  have 
realized  fully  the  truth  of  this  statement,  for  during 
the  second  year  of  his  stay  at  Montpellier  he  joined 
a  secret  band  of  nocturnal  grave-robbers  who  were 
determined  at  all  hazards  to  obtain  the  material  needed  for 
self-instruction.  The  following  brief  description  of  one 
of  the  raids  made  by  this  band  of  eager  searchers  after 
knowledge  will  convey  a  good  idea  of  the  manner  in  which 
the  work  was  conducted : — 

Our  first  excursion  of  this  kind  was  made  on  Dec.  11th,  1554. 
As  soon  as  it  was  really  dark  our  fellow  student  Gallotus  guided 
us,  along  the  road  that  leads  to  Nimes,  to  the  Augustinian  Monas- 
tery, which  is  situated  about  half-way  between  Castelnau  and  the 
Verdanson  brook.  Here  we  were  received  by  a  monk  called 
Brother  Bernard,  a  bold  and  determined  fellow,  who  had  disguised 
himself  for  the  business  in  hand.  At  midnight,  after  we  had  par- 
taken of  food  and  drink,  we  started  out,  sword  in  hand,  for  the 
cemetery  which  is  located  close  to  the  church  of  Saint  Denis.  Here 
we  dug  up  with  our  hands  a  corpse  which  had  been  interred  that 
very  day;  and,  having  lifted  it  out  of  the  pit  by  means  of  ropes, 
and  wrapped  our  cloaks  around  it,  we  carried  the  body  on  two 
canes  as  far  as  Montpellier.  Then,  having  concealed  our  load 
close  to  the  postern,  alongside  the  city  gateway,  we  summoned  the 
keeper  and  begged  him  to  get  us  some  wine,  as  we  were  dying  of 
thirst  and  very  tired.  "While  he  was  absent  in  search  of  the  wine 
three  of  our  party  slipped  in  through  the  passage  and  carried  the 
corpse  safely  to  Gallotus'  house,  which  was  only  a  short  distance 


EVENTS  PRECEDING  THE  RENAISSANCE  337 

from  the  gate.  The  gate-keeper  returned  in  due  time  with  the 
wine,  and  did  not  appear  to  have  the  slightest  suspicion  of  the  trick 
that  we  had  played  upon  him.  It  was  now  three  o'clock  in  the 
morning. 

The  control  exercised  by  the  authorities  over  the  practice 
of  dissecting  human  corpses  differed  very  appreciably  at 
different  dates  in  different  parts  of  Europe.  Thus,  for 
example,  orders  were  issued  to  the  Italian  bishops  during 
the  latter  part  of  the  fourteenth  century  to  put  a  stop  to 
further  dissections,  and  for  a  period  of  over  one  hundred 
years  these  orders  accomplished  the  purpose  desired.  On 
the  other  hand,  the  Emperor  Charles  the  Fourth  adopted 
a  more  liberal  course :  from  the  year  1348  on  he  permitted 
dissections  of  human  corpses  to  be  made  without  hindrance 
in  Prague,  Bohemia,  but  his  liberality  in  this  particular 
appears  to  have  been  of  little  use,  for  there  is  no  evidence 
to  show  that  the  knowledge  of  anatomy  made  any  appre- 
ciable advance  anywhere  in  Europe  until  after  the  begin- 
ning of  the  sixteenth  century. 

Gabriel  Zerbi  of  Verona  (1468-1505)  published  at  Venice 
in  1502  the  first  modern  treatise  on  human  anatomy  that 
deserves  to  receive  special  mention.  Pagel  speaks  of  it 
as  containing  fairly  good  descriptions  of  different  parts 
of  the  body.  Zerbi  held  the  Chair  of  Medicine,  Logic  and 
Philosophy  in  the  University  of  Padua,  and  lectured  first 
in  that  city,  next  at  Bologna,  and  finally  at  Rome.  One 
incident  in  his  career  may  prove  of  interest  to  the  reader 
as  showing  the  fearful  risks  to  which  a  practicing  physician 
in  those  days  was  sometimes  exposed.  The  incident  was 
of  this  nature : — 

A  wealthy  pacha  in  Constantinople,  failing  to  obtain  relief  from 
his  malady  at  the  hands  of  the  native  Turkish  doctors,  summoned 
an  Italian  physician  from  Venice.  Zerbi,  whom  the  ruling  Doge 
invited  to  accept  the  summons,  sailed  immediately  for  Constanti- 
nople in  company  with  his  two  sons  who  were  mere  lads.  The 
treatment  which  he  inaugurated  proved  promptly  successful,  and 
Zerbi,  having  been  handsomely  remunerated  for  his  services,  was 
already  on  his  way  back  to  Venice  when  his  ship  was  overhauled  by 
a  swift-sailing  caique  on  board  of  which  were  the  sons  of  his  recent 

/ 


338  GROWTH  OF  MEDICINE 

patient,  who — as  the  story  goes — had  celebrated  his  recovery  by 
eating  and  drinking  to  excess.  This  debauch  promptly  caused  his 
death — probably  by  cerebral  apoplexy ;  but  the  sons  were  convinced 
that  it  was  the  result  of  poison  administered  by  Zerbi,  and  accord- 
ingly they  lost  no  time  in  starting  out  to  capture  the  supposed 
murderer.  Their  first  act,  on  reaching  the  vessel  which  they  were 
pursuing,  was  to  kill  the  younger  of  the  two  sons,  in  the  presence 
of  the  father,  by  sawing  his  body  in  two  lengthwise.  Then  they 
killed  Zerbi  himself  in  the  same  manner. 

Tiraboschi,  the  first  historian  of  Italian  literature  (1731- 
1794),  is  mentioned  by  Dezeimeris  as  his  authority  for  this 
terrible  tale.    The  events  here  narrated  occurred  in  1505. 

At  the  beginning  of  the  sixteenth  century — the  period 
with  which  our  history  now  has  to  deal — ^the  only  available 
knowledge  of  anatomy  was  that  which  had  been  supplied 
by  Galen  in  the  third  century  of  the  Christian  era,  and 
which  had  been  handed  down  through  all  the  intervening 
centuries  as  something  absolutely  correct  and  not  to  be 
challenged.  But  the  time  had  arrived  when  men  were  no 
longer  willing  to  accept  as  truth  the  teachings  of  any 
individual  until  they  had  subjected  them  afresh  to  the  most 
searching  investigations;  and  thus  it  came  about  that  a 
group  of  remarkably  able  men  devoted  all  their  energies, 
during  the  greater  part  of  the  sixteenth  century,  to  a  very 
critical  study  of  human  anatomy.  As  the  work  accom- 
plished by  these  men  constitutes  a  very  important  chapter — 
perhaps  the  most  important  chapter — ^in  the  history  of 
medicine,  I  may  be  pardoned  if  I  devote  a  disproportion- 
ately large  amount  of  space  to  the  consideration  of  the 
careers  of  the  more  prominent  of  these  founders  of  modern 
anatomy,  and  to  an  enumeration  of  the  details  of  the  work 
which  they  accomplished,  and  which  furnished  the  most 
complete  verification  of  the  truth  stated  by  Francis  Bacon, 
Lord  Verulam  (1561-1626),  in  the  following  words  (trans- 
lation) : — 

Man  has  no  other  means  of  getting  at  and  revealing  the  truth 
than  by  induction  coupled  with  a  never-tiring,  unprejudiced 
observation  of  nature  and  an  imitation  of  her  operations.    Actual 


EVENTS  PRECEDING  THE  RENAISSANCE  339 

facts  must  first  be  collected,   and  not  created  by  a  process  of 
speculation. 

One  of  the  earliest  and  most  thorough  students  of  human 
anatomy  was  Marc  Antonio  della  Torre  (1473-1506),  who 
belonged  to  an  honorable  family  of  Verona,  several  mem- 
bers of  which  had  attained  distinction  as  physicians.  He 
planned  to  publish  a  treatise  on  anatomy,  and,  with  this 
object  in  view,  secured  the  assistance  of  Leonardo  da  Vinci 
(1452-1515),  the  celebrated  painter,  architect  and  civil 
engineer,  to  make  life-size  pictures  of  the  parts  which  he 
had  dissected  with  such  care.  But,  after  the  latter  had 
completed  many  of  the  drawings  which  were  intended  to 
serve  as  illustrations  for  the  projected  treatise,  Della  Torre 
unexpectedly  died,  and  the  book  was  never  finished.  Quite 
a  number  of  the  drawings,  however,  found  their  way  to 
England,  and  for  many  years  past  they  have  been  carefully 
treasured  at  Windsor  Castle  and  in  certain  private 
collections.  If  Delia  Torre's  life  had  been  spared  it  is 
highly  probable  that  his  treatise  on  anatomy,  equipped  with 
illustrations  copied  from  this  great  artist's  dramngs,  would 
have  constituted  a  formidable  rival  of  Vesalius'  famous 
work. 

Not  long  after  this  event  it  became  the  rule,  among  the 
leading  painters  and  sculptors  of  the  Renaissance  period, 
to  pay  a  great  deal  of  attention  to  the  study  of  human 
anatomy.  The  museums  of  Central  and  Southern  Italy 
contain  quite  a  large  number  of  anatomical  drawings  that 
were  made  by  Michael  Angelo,  by  Raphael  and  by  other 
great  masters  of  that  period.  Doubtless  many  of  my 
readers  recall  seeing,  in  the  Cathedral  of  Milan,  Marco 
Agrate's  (1562)  extraordinary  masterpiece,  in  the  form 
of  a  life-size  black  marble  statue  which  represents  Saint 
Bartholomew  standing  erect,  and  carrying  on  one  arm  the 
folded  skin  of  his  entire  body.  In  this  statue  all  the  muscles 
and  bony  prominences  are  modeled  with  perfect  accuracy. 
It  is  a  remarkable  work  of  art. 


CHAPTER  XXVII 

THE  FOUNDERS  OF  HUMAN  ANATOMY  AND 
PHYSIOLOGY 

Among  the  earliest  physicians  of  this  period  to  inculcate 
the  importance  of  substituting  a  correct  knowledge  of 
anatomy  for  the  frequently  incorrect  descriptions  that  had 
been  prepared  by  Galen  and  handed  down  through  the 
succeeding  centuries,  were  the  following :  Jacques  DuBois 
of  Paris  (1478-1555),  who  was  perhaps  better  known  by 
his  latinized  name  of  "Sylvius";  Guido  Guidi  (died  in 
1569),  who  was  also  known  as  "Vidus  Vidius";  and 
Winther  of  Andernach,  a  small  city  on  the  Rhine.  These 
three  men,  all  of  whom  taught  anatomy  at  Paris,  were 
commonly  considered  the  best  anatomists  of  that  early 
period.  DuBois  was  further  entitled  to  the  credit  of  having 
been  the  first  physician  to  inject  blood-vessels  with  a 
material  that  renders  them  more  easily  visible,  and  also 
the  first  person  in  Paris  to  dissect  a  human  corpse.  It  was 
from  these  men  that  Vesalius,  who  afterward  became  such 
a  famous  anatomist,  received  his  first  practical  instruction 
in  this  branch  of  medical  science.  Nothing  further  need 
be  said  here  of  DuBois,  but  brief  sketches  of  Guido  Guidi 
and  of  Berengarius  of  Carpi,  another  contemporary 
anatomist  of  considerable  distinction,  deserve  to  find  places 
in  our  history  of  this  period.  Vesalius'  facetious  remark 
that  ''Winther  of  Andernach  never  used  a  knife  except  for 
the  purpose  of  dissecting  his  food"  absolves  us  from  the 
duty  of  saying  anything  further  about  his  career  as  an 
anatomist. 

In  1542  Francis  the  First,  King  of  France,  gave  a  great 
impulse  to  the  study  of  medicine  by  calling  Guido  Guidi 
from  Florence,  Italy,  to  teach  that  science  in  the  College 


HUMAN  ANATOMY  AND  PHYSIOLOGY      341 

de  France,  an  institution  which  he  had  founded  at  Paris 
in  1530.  Guidi,  upon  his  arrival  in  Paris,  was  at  once  most 
cordially  received,  both  by  those  who  were  to  be  his  col- 
leagues and  by  the  King.  Francis  bestowed  upon  him  a 
suitable  gift,  appointed  him  to  the  position  of  First 
Physician  (Archiater)  at  his  Court,  and  assured  him  that 
he  would  receive  an  ample  salary  during  his  residence  in 
the  French  metropolis.  In  1547,  after  the  death  of  Francis 
the  First,  Guidi  returned  to  his  home  in  Florence,  where 
Cosimo  dei  Medici,  at  that  time  the  head  of  the  Florentine 
Republic  and  a  little  later  Grand  Duke  of  Tuscany 
(Cosimo  III.),  made  him  his  First  Physician  and  gave  him 
the  appointment  of  Professor  of  Philosophy  in  the  Univer- 
sity of  Pisa.  Not  long  afterward  Guidi  was  transferred 
to  the  Chair  of  Medicine.  He  retained  this  position  almost 
up  to  the  time  of  his  death  (May  26, 1569),  and  during  this 
long  period  Cosimo  bestowed  upon  him  various  ecclesiastic 
honors,  which  not  only  increased  his  social  rank  but  added 
materially  to  his  financial  resources. 

Dezeimeris  says  that,  while  Guidi  does  not  deserve  to 
be  placed,  as  an  anatomist,  in  the  same  rank  with  Vesalius 
and  Fallopius,^  he  merits  full  credit  for  the  very  important 
service  which  he  rendered  the  physicians  of  his  day  by 
placing  within  their  reach  translations  of  certain  Greek 
treatises  relating  to  surgical  topics — such  treatises,  for 
example,  as  those  of  Hippocrates  on  ulcers,  on  wounds  of 
the  head,  on  the  joints  and  on  fractures  (with  Galen's 
comments),  Galen's  treatise  on  fasciae,  and  that  of  Ori- 
basius  on  ligatures  and  other  surgical  contrivances. 

Apart  from  his  merits  as  a  worker  in  the  field  of  medical 
science,  Guidi  occupies  a  creditable  place  in  the  history 
of  medicine  as  a  fine  type  of  the  well-educated  and  kindly 
disposed  physician,  as  the  following  testimony  given  by 
Benvenuto  Cellini,  the  distinguished  Florentine  sculptor, 
shows : — 

On  the  occasion  of  my  visit  to  Paris  I  made  the  acquaintance  of 
Messer  Guidi,  and  I  wish  to  state  in  what  a  very  friendly  manner 

1  Also  often  spelled  '  *  Falloppius. ' ' 


342  GROWTH  OF  MEDICINE 

I  was  received  by  that  noble  citizen  of  Florence  and  excellent 
physician,  the  most  virtuous,  the  most  lovable,  and  the  most 
domestic  man  whom  I  have  ever  met. 

Guidi  's  treatise  on  anatomy  was  first  published  at  Venice 
(under  the  editorship  of  his  nephew)  in  1611 — i.e.,  forty- 
two  years  after  his  death.  His  translations  from  the  Greek 
treatises  of  Hippocrates,  Galen  and  Oribasius  will  be  found 
in  the  work  which  bears  the  title  ^^Collectio  Chirurgica 
Parisina,'^  Paris,  1544. 

Berengarius  of  Carpi  (a  small  town  in  Northern  Italy), 
who  died  in  1530,  is  pronounced  by  Kurt  Sprengel  a  worthy 
predecessor  of  Vesalius.  He  was  Professor  of  Anatomy, 
first  at  Pavia  and  then  at  Bologna  (from  1502  to  1527),  and 
he  is  reported  to  have  dissected  more  than  one  hundred ( !) 
cadavers  during  that  period.  Fallopius  and  Eustachius 
were  among  his  pupils,  and  it  was  their  opinion  that  he 
did  more  than  anybody  else  to  revive  the  interest  in 
anatomical  work.  The  famous  sculptor,  Benvenuto  Cellini 
(1500-1571),  is  authority  for  the  statement  that  Berengarius 
was  not  only  an  experienced  anatomist  and  practicing 
physician,  but  also  a  very  skilful  draughtsman;  the  three 
works  which  he  published  being  illustrated  with  a  certain 
number  of  original  woodcuts  that  are  not  without  interest 
both  to  the  anatomist  and  to  the  lover  of  art. 

Andreas  Vesalius  (1514-1564)  was  born  at  Brussels,  of 
German  parents  whose  home  was  located  at  Wessels  on  the 
Rhine, — ^whence  the  name  ''Vesalius."  His  father  was  the 
apothecary  of  the  Princess  Margaretha,  Charles  the  Fifth's 
aunt,  and  several  of  his  ancestors  had  been  physicians  of 
considerable  distinction.  At  Louvain  he  received,  in  early 
youth,  a  thorough  training  in  the  Latin,  Greek  and  Arabic 
languages  and  also  in  mathematics.  When  he  was  about 
eighteen  years  of  age,  he  visited  Montpellier  and  afterward 
Paris,  at  which  latter  city  he  received  practical  instruction 
in  anatomy  from  the  three  men  whose  names  I  have 
mentioned  in  the  preceding  paragraph — ^viz.,  Guido  Guidi, 
Jacques  DuBois  and  Winther  of  Andernach.  The  instruc- 
tion in  anatomy  given  in  Paris  at  that  period  (about  1533) 
consisted  in  interpretations  of  Galen's  teachings,  in  dis- 


HUMAN  ANATOMY  AND  PHYSIOLOGY      343 

sections  of  a  few  animals,  and  in  occasional  demonstra- 
tions— which  never  lasted  longer  than  three  days — of  the 
easily  accessible  parts  of  a  human  cadaver.  Scanty  as  were 
these  sources  of  information,  Vesalius  cultivated  them  with 
the  greatest  zest.  From  time  to  time  his  teacher,  DuBois, 
noting  the  interest  which  his  pupil  took  in  anatomy,  and 
recognizing  his  fitness  for  imparting  instruction,  assigned 
to  him  the  special  duty  of  rehearsing,  in  the  auditorium, 
before  his  fellow  students,  the  essential  facts  of  the  day's 
lecture.  After  war  had  been  declared  between  the  Emperor 
Charles  the  Fifth  and  Francis  the  First,  King  of  France, 
Vesalius  left  Paris  and  returned  to  Louvain,  where  he 
began  lecturing  on  anatomy.  These  lectures  constituted 
the  very  first  attempt  at  anything  like  systematic  instruc- 
tion in  anatomy  that  is  known  to  have  been  made  at  that 
ancient  university.  It  was  while  he  was  engaged  in  this 
work  that  Vesalius,  in  order  to  become  the  possessor  of  an 
entire  human  skeleton, — a  thing  of  which  he  felt  a  very 
great  need, — ventured  to  remove  from  the  gallows,  outside 
the  city,  the  cadaver  of  a  criminal.  This,  as  Haeser 
declares,  was  an  act  of  great  boldness  and  full  of  peril. 

The  life  of  a  military  surgeon  attached  to  the  army  of 
Charles  the  Fifth,  which  was  the  life  that  Vesalius  led  dur- 
ing the  following  year  or  two,  was  not  sufficiently  attractive 
to  divert  his  mind  seriously  from  his  favorite  study;  and 
it  is  therefore  not  surprising  that  we  find  him,  at  the  age 
of  twenty-three,  accepting  from  the  Senate  at  Venice  the 
appointment  of  the  professorship  of  anatomy  at  the 
University  of  Padua.  When  he  entered  upon  this  new  work 
Vesalius  felt  considerable  uncertainty  as  to  the  correctness 
of  the  anatomy  which  he  was  then  teaching,  and  it  is  there- 
fore easy  to  understand  why  his  first  three  lectures  were 
based  entirely  upon  the  teachings  of  Galen ;  but,  before  he 
had  finished  the  third  one  of  the  series,  he  made  up  his 
mind  that  he  would  cut  loose  from  the  anatomy  of  the  ape 
and  confine  himself  to  that  of  the  human  subject,  as  was 
then  being  revealed  to  him  more  and  more  perfectly  from 
his  own  dissections.  The  stock  of  knowledge  which  he  had 
thus  begun  to  accumulate,  increased  steadily  until,  after 


344  GROWTH  OF  MEDICINE 

seven  years  of  teaching  at  Padua,  Bologna  and  Pisa,  at 
each  of  which  schools  of  medicine  he  gave  courses  in 
anatomy  of  seven  weeks'  duration,  and  after  conducting 
the  most  painstaking  dissections  of  a  number  of  human 
cadavers,  he  finally  declared  that  he  was  ready  to  publish 
his  great  treatise  on  anatomy.  Some  of  his  friends,  fore- 
seeing clearly  what  a  storm  of  protest  the  new  book  would 
arouse  among  the  followers  of  Galen,  urged  him  to  postpone 
for  a  time  its  publication;  but  a  few  others  agreed  with 
him  that  it  should  be  issued  without  further  delay. 
Accordingly  Vesalius  sent  the  manuscript  of  his  work  at 
once  to  the  printers  at  Basel,  and  the  book  was  finally 
published  in  June,  1543,  before  its  author  had  attained  his 
twenty-ninth  year.  Its  title  was  ^^De  corporis  humani 
fabrica/'  and  it  was  provided  with  exceptionally  fine  pic- 
torial illustrations,  most  of  which  were  drawn,  as  is  gener- 
ally believed,  by  John  de  Calcar,  one  of  Titian's  pupils. 
A  second  edition,  superior  in  every  respect  to  the  first,  was 
published  in  1555.  In  comparison  with  this  great  work 
the  few  treatises  written  by  Vesalius  in  later  years  are  of 
minor  importance. 

Vesalius  may  rightly  be  considered  the  founder  of  modern 
anatomy,  for  he  was  the  first  to  furnish  correct  information, 
based  on  actual  dissections  of  the  human  cadaver,  respect- 
ing quite  a  large  number  of  the  more  important  anatomical 
relations;  and  by  this  very  act  he  won  the  further  credit 
of  having  dealt  the  first  effective  blow  toward  the  dethrone- 
ment of  Galen,  the  man  who,  next  to  Hippocrates, — 
probably  even  more  than  Hippocrates, — had  exercised,  by 
his  teachings  in  nearly  every  department  of  medical 
science,  almost  despotic  sway  over  physicians  for  consider- 
ably more  than  one  thousand  years.  At  this  distance  of 
time,  it  is  hard  to  realize  what  a  startling  effect  was  pro- 
duced by  the  announcement  of  the  discovery  of  so  many 
errors  in  Galen's  scheme  of  anatomy.  Albert  von  Haller, 
the  great  authority  on  medical  literature,  speaks  of 
Vesalius'  book  as  an  "immortal  work";  and,  although  its 
title  would  lead  one  to  suppose  that  it  deals  only  with  the 
construction  of  the  human  body,  an  examination  of  its 


ff 


FIG.  14.    ANDREAS  VESALIUS. 

(After  the  portrait  by  Van  Calcar  in  the  Royal  College  of  Surgeons, 
London.) 

Copied  from  the  reproduction  publi.shed  in  the  Nederlandsch  Tijdschrift 
voor  Geneeskunde,  Jan.  2,  1915. 


HUMAN  ANATOMY  AND  PHYSIOLOGY      345 

contents  reveals  the  fact  that  it  contains  in  addition  quite 
full  information  regarding  physiology  and  pathological 
anatomy,  as  well  as  many  details  relating  to  comparative 
anatomy.  Perhaps  the  most  marvelous  thing  about  this 
book  is  the  fact  that  its  author  completed  his  work  before 
he  had  reached  his  twenty-eighth  year.  It  may  also  interest 
the  reader  to  learn  that,  prior  to  1914,  the  University  of 
Louvain  possessed  a  copy  of  Vesalius'  great  work  printed 
on  vellum  and  illustrated  with  many  drawings  in  colors; 
but  I  am  unable  to  say  whether  this  beautiful  volume  did 
or  did  not  escape  destruction  at  the  hands  of  the  ruthless 
men  who  invaded  Belgium  during  the  summer  of  that 
memorable  year. 

When  the  human  mind  has  adjusted  itself,  in  the  course 
of  years,  to  consider  certain  beliefs  and  ideas  as  settled 
truths,  it  comes  as  a  painful  shock  to  be  told  that  these 
beliefs  are  erroneous  and  that  new  ones  must  take  their 
places.  This  is  precisely  what  happened  when  Vesalius' 
book  was  first  published.  From  one  end  of  Europe  to  the 
other  there  was  a  very  great  stir  among  the  well-educated 
physicians ;  the  more  liberal  minded  being  ready  to  accept 
at  once  the  genuineness  of  the  new  anatomy,  whereas 
others, — and  possibly  they  represented  the  larger  num- 
ber,— acting  under  the  influence  of  personal  jealousy  or 
perhaps  blinded  by  the  belief  that  it  was  impious  not  to 
accept  without  questioning  the  descriptions  made  by 
Galen,  were  scandalized  by  the  boldness  of  Vesalius  in 
asserting  that  many  of  the  statements  made  by  this  great 
medical  authority  were  incorrect.  Jacques  DuBois,  whose 
name  has  been  mentioned  by  me  on  a  previous  page,  was  one 
of  the  most  bitter  of  Vesalius'  assailants.  In  a  pamphlet 
which  he  published  in  Paris  in  1551  he  even  went  so  far  as 
to  speak  of  his  late  pupil  as  '  *  a  crazy  fool  who  is  poisoning 
the  air  of  Europe  with  his  vaporings."  On  account  of 
their  former  pleasant  relations,  and  also  because  DuBois 
was  at  that  time  an  old  man,  Vesalius  made  no  reply  to 
these  attacks;  but  when  Bartholomaeus  Eustachius,  Pro- 
fessor of  Anatomy  at  Rome,  one  of  the  most  celebrated 
anatomists  of  that  period,  and  a  man  of  his  own  age,  entered 


346  GROWTH  OF  MEDICINE 

the  lists  as  the  champion  of  Galen,  Vesalius  took  up  the 
challenge,  left  the  work  upon  which  he  was  then  engaged, 
and  began  a  tour  of  visits  to  the  universities  of  Padua, 
Bologna  and  Pisa,  for  the  express  purpose  of  disproving, 
by  the  aid  of  numerous  dissections,  the  statements  made 
by  his  antagonists.  Throughout  this  tour  he  was  received 
everywhere  with  enthusiasm,  the  older  men  among  the 
teachers  of  anatomy  vying  with  the  younger  in  manifesting 
the  strength  of  their  approval.  The  entire  journey,  says 
Haeser,  was  from  beginning  to  end  a  series  of  the  most 
brilliant  triumphs.  But,  notwithstanding  this  vindication, 
which  most  men  would  have  accepted  with  the  greatest 
satisfaction,  Vesalius  returned  to  his  home  in  Brussels  only 
to  find  that  the  bitter  attacks  made  by  his  enemies  had  not 
ceased.  This  depressed  him  greatly,  for  he  was  not 
philosophical  enough  to  recognize  the  facts  that  jealousy 
was  at  the  bottom  of  this  ill  feeling  toward  him,  and  also 
that  sufficient  time  had  not  yet  elapsed  for  the  news  of  his 
triumphant  vindication  to  travel  from  Italy  to  Belgium. 
While  suffering  from  this  fit  of  the  blues  he  committed  to 
the  flames  all  his  books  and  manuscripts.  These  latter,  it 
appears,  contained  not  only  the  fruits  of  many  years  of 
laborious  anatomical  and  physiological  research,  but  also 
a  large  number  of  memoranda  relating  to  pathological 
anatomy. 

In  1556,  complaints  having  reached  the  ears  of  Charles 
the  Fifth  to  the  effect  that  the  sin  of  dissecting  human 
corpses  was  greatly  on  the  increase,  this  monarch  decided 
to  refer  the  question  to  the  Theological  Faculty  of  the 
University  of  Salamanca,  in  the  northwestern  part  of 
Spain,  for  an  authoritative  opinion.  The  reply  which  these 
broad-minded  theologians  sent  to  the  Emperor  was  most 
satisfactory.  It  is  reported  to  have  been  expressed  in  the 
following  words:  "The  dissection  of  human  cadavers 
serves  a  useful  purpose  and  is  therefore  permissible  to 
Christians  of  the  Catholic  Church. ' '  This  decision  did  not 
of  course  put  an  immediate  end  to  the  harsh  criticisms  and 
petty  persecutions  of  the  bigots ;  but,  as  the  years  went  by, 
it  was  noted  that  the  work  of  scientific  research  in  human 


HUMAN  ANATOMY  AND  PHYSIOLOGY       347 

anatomy  and  physiology  acquired  greater  freedom  of 
action,  and  it  is  fair  to  assume  that  this  result  was  largely 
due  to  the  famous  decision  to  which  I  have  just  referred. 

Shortly  after  Vesalius  had  retired,  as  stated  above,  from 
active  participation  in  anatomical  research  work,  he  was 
called  by  Charles  the  Fifth  to  serve  him  in  the  capacity  of 
private  physician.  During  this  service,  which  lasted  for 
several  years,  he  visited,  in  company  with  the  Emperor, 
many  of  the  principal  cities  of  Europe ;  and  then,  when  the 
latter  abdicated  the  throne  of  Spain, — for  Charles  was  not 
only  Emperor  of  the  Holy  Eoman  Empire  but  also  King 
of  Spain, — Vesalius  became  the  private  physician  of  Philip 
the  Second,  Charles'  son  and  successor  on  the  Spanish 
throne.  This  long  period  is  largely  a  blank  in  the  history 
of  Vesalius.  Toward  the  end  he  got  into  trouble  with  the 
Inquisition  and  was  obliged,  as  a  means  of  escaping  the 
punishment  of  death,  to  undertake  a  voyage  to  the  Holy 
Sepulchre  in  Jerusalem.  While  he  was  in  that  city  he 
received  an  official  invitation  from  the  Senate  at  Venice 
to  fill  the  Chair  of  Anatomy  at  Padua.  He  then  at  once 
turned  his  steps  toward  Italy,  doubtless  very  happy  over 
the  prospect  of  once  more  engaging  in  anatomical  work; 
but  he  was  shipwrecked  on  the  coast  of  the  Island  of  Zante, 
October  2,  1564.  Thirteen  days  later,  before  he  had  com- 
pleted his  fiftieth  year,  he  died  from  starvation  and 
exposure.  A  memorial  tablet  was  placed  in  one  of  the 
neighboring  churches  on  the  island,  and  in  1847  his  Belgian 
compatriots  erected  a  suitable  monument  to  his  memory 
in  the  city  of  Brussels. 

Admirable  as  was  Vesalius'  treatise  on  human  anatomy, 
it  was  soon  discovered  that  it  was  deficient  in  certain 
particulars.  Not  a  few  of  the  descriptions,  for  example, 
were  incomplete,  and  there  were  also  a  number  of  parts  or 
organs  for  which  no  descriptions  whatever  had  been 
provided.  Many  of  these  deficiencies  were  supplied  by 
contemporary  anatomists,  nearly  all  of  whom  were  Italians. 
First  and  foremost  among  this  secondary  but  yet  very 
important    group    of   laborers    in    the    field    of    original 


348  GROWTH  OF  MEDICINE 

research  work,  the  names  of  Fallopius  and  Eustachius 
deserve  to  be  mentioned. 

Gabriele  Fallopius,  who  was  born  in  Modena  in  1523, 
was  appointed  to  the  Chair  of  Anatomy  at  Ferrara  when 
he  was  only  twenty-four  years  of  age.  Subsequently  he 
taught  at  the  University  of  Pisa.  At  the  time  of  his  death 
in  1563  he  was  Professor  of  Anatomy,  Surgery  and  Botany 
at  Padua.  He  made  many  important  discoveries  in  anat- 
omy, more  particularly  in  relation  to  foetal  osteology  and 
the  distribution  of  the  blood-vessels.  His  work  in  the  latter 
department  is  all  the  more  remarkable  from  the  fact  that 
it  was  accomplished  at  a  time  when  the  art  of  injecting 
blood-vessels  with  some  opaque  material  was  unknown  in 
Italy.  His  name  has  been  perpetuated  in  connection  with 
the  Fallopian  tube.  As  a  man  Fallopius  was  much  liked 
because  of  his  kindly  disposition  and  absence  of  conceit. 
The  only  treatise  which  he  published  was  that  entitled 
^^Ohservationes  anatomicae,^*  Venice,  1561. 

Bartholomaeus  Eustachius,  born  at  San  Severino,  in  the 
Marches  of  Ancona,  in  the  early  part  of  the  sixteenth 
century,  was  one  of  the  most  distinguished  physicians  of 
his  day.  He  taught  anatomy  at  the  famous  University  of 
Sapienza  at  Rome,  and  devoted  a  great  deal  of  time  and 
thought  to  the  preparation  of  a  large  work  which  was 
to  bear  the  title  ''On  the  Dissensions  and  Controversies 
Relating  to  Anatomy";  but  death  overtook  him  before  he 
had  completed  this  undertaking.  It  appears,  however,  that 
in  1564^that  is,  ten  years  before  he  died — he  published  a 
smaller  work  containing  separate  chapters  on  the  kidneys, 
the  organ  of  hearing,  the  movements  of  the  head,  the  vena 
azygos,  the  vena  profunda  of  the  arm,  and  on  certain 
questions  relating  to  osteology;  and  he  introduced,  as 
illustrations  for  the  text,  eight  plates  of  octavo  size.  These 
plates  and  thirty-eight  others,  which  were  to  have  served 
as  illustrations  for  the  great  work,  were  all  completed  as 
early  as  during  the  year  1552.  The  artist  Pini,  who  made 
the  drawings  that  served  as  the  originals  from  which  the 
plates  were  made,  was  related  in  some  degree  to  Eustachius, 
and  upon  the  latter 's  death  the  metal  plates  became  his 


HUMAN  ANATOMY  AND  PHYSIOLOGY      349 

property  by  inheritance.  But  nothing  further  was  heard 
of  them  until  they  were  discovered,  early  in  the  eighteenth 
century,  by  Lancisi,  the  Pope's  attending  physician,  in  the 
possession  of  Pini's  descendants.  They  were  published 
for  the  first  time  in  1714.  Haeser  says  that  these  pictures 
are  true  to  nature,  but  that  in  artistic  merit  they  are  not 
equal  to  those  which  belong  to  the  treatise  published  by 
Vesalius.  The  name  Eustachius  is  permanently  connected 
with  the  channel  which  leads  from  the  tympanum  to  the 
nasal  cavities — the  Eustachian  tube. 

Only  the  briefest  possible  mention  may  here  be  made 
of  those  anatomists  who,  following  immediately  in  the  foot- 
steps of  the  three  great  leaders  mentioned  above,  played 
parts  of  greater  or  less  importance  in  building  up  the 
science  of  anatomy.  Each  one  of  them  did  creditable  work 
in  correcting  the  errors  made  by  their  predecessors  or  in 
supplying  descriptions  of  structures  or  structural  relations 
which  these  pioneers  had  overlooked.  Thus,  long  before 
the  sixteenth  century  came  to  an  end,  the  gross  anatomy 
of  the  human  being  had  attained  a  large  measure  of  the 
completeness  which  it  possesses  to-day.  The  names  of 
some  of  the  more  prominent  men  among  those  to  whom 
I  have  just  referred  are  the  following:  Giovanni  Filippo 
Ingrassia,  Matthaeus  Realdus  Columbus,  Julius  Caesar 
Arantius,  Constantius  Varolius,  Volcher  Koyter  and 
Hieronymus  Fabricius  ab  Acquapendente. 

Ingrassia  (1510-1580),  a  Sicilian  physician,  cultivated 
osteology  assiduously,  and  is  entitled  to  special  credit  for 
having  first  described  the  stapes,  the  third  one  of  the 
ossicles  of  hearing,  and  for  having  made  valuable  contri- 
butions to  our  knowledge  of  epidemic  diseases.  He  was  a 
professor  in  the  University  of  Naples,  and,  after  the  year 
1563,  held  the  position  of  Archiater  in  Palermo,  Sicily. 
His  descriptions  of  the  diiferent  bones  of  the  skeleton  were 
made  with  such  care  and  thoroughness  that  later  anatomists 
found  very  little  for  them  to  discover  or  to  alter. 

Matthaeus  Realdus  Columbus  (or  simply  Realdus 
Columbus),  who  died  in  1559,  was  born  in  Cremona, 
Northern  Italy.     He  served  for  some  time  as  Prosector 


350  GROWTH  OF  MEDICINE 

to  Vesalius  at  Padua,  and  then  succeeded  him  in  the  Chair 
of  Anatomy,  first  at  Padua  and  afterward  at  Pisa.  The 
last  teaching  position  which  he  held  was  that  of  Professor 
of  Anatomy  in  Rome,  in  which  city  he  counted  Michael 
Angelo  among  his  intimate  friends.  The  discoveries  which 
he  made  in  anatomy  were  quite  numerous  and  of  consider- 
able importance,  and  his  descriptions  were  distinguished 
by  an  unusual  degree  of  accuracy  and  clearness.  Unfortu- 
nately, he  did  not  hesitate,  at  the  same  time,  to  exalt  the 
value  of  his  own  work  by  disparaging  that  of  his  famous 
teacher. 

Arantius,  who  also  was  one  of  the  pupils  of  Vesalius, 
occupied  the  Chair  of  Anatomy  in  his  native  city  of  Bologna 
during  the  latter  half  of  the  century.  His  death  occurred 
in  1589.  The  particular  department  in  which  he  gained 
considerable  fame  was  that  of  the  foetus,  the  placenta,  the 
uterus,  etc.  His  descriptions  of  these  structures  are 
written  with  very  great  care.  Blumenbach  gives  him  credit 
for  having  been  the  first  anatomist  to  furnish  a  description 
of  the  pregnant  uterus  in  its  different  stages.  His  earliest 
published  work  bears  the  title  ^^De  humano  foetu  opus- 
culum,'^  Rome,  1564. 

Constantinus  Varolius,  whose  name  is  imperishably 
connected  with  that  part  of  the  brain  which  is  known  as 
the  "Pons  Varolii,"  was  born  in  Bologna  in  1543.  He  was 
appointed  Professor  of  Anatomy  in  the  Academy  of  his 
native  city  at  an  early  age,  and  soon  distinguished  himself 
by  the  careful  studies  which  he  made  of  the  human  brain 
and  nervous  system  in  general.  Before  his  untimely  death 
at  the  age  of  thirty-two  he  was  chosen  the  attending 
physician  of  Pope  Gregory  the  Thirteenth.  His  earliest 
published  work  bears  the  title  *'Z)e  nervis  opticis,  etc., 
epistola,"  Padua,  1573. 

Volcher  Koyter,  who  was  born  at  Groningen,  North 
Holland,  in  1534,  studied  under  Fallopius  and  Guillaume 
Rondelet  (1507-1566),  to  whom  the  University  of  Mont- 
pellier  was  indebted  for  its  anatomical  theatre,  and  to 
whom  (rather  than  to  Gaspard  Bauhin  of  Basel)  is  due 
the  honor  of  discovering  the  ileo-caecal  valve.    Koyter  was 


HUMAN  ANATOMY  AND  PHYSIOLOGY      351 

one  of  the  earliest  workers  in  the  field  of  comparative 
anatomy — a  department  of  knowledge  to  which  Vesalius 
had  already  made  some  creditable  additions ;  and  his  two 
most  important  published  treatises  bear  these  titles: 
'*Z)e  ossibus  et  cartilaginihus  corporis  Jiumani  tabulae^* 
(Bologna,  1566),  and  ^^Externarum  et  internarum  princi- 
palium  humani  corporis  partium  tabulae^ ^  (Nuremberg, 
1573).    He  died  in  1600. 

Hieronymus  Fabricius  was  born  in  1537  at  Acquapen- 
dente,  a  small  city  of  Etruria,  about  fifty  miles  northwest 
of  Rome.  He  studied  anatomy  at  Padua  under  Fallopius, 
and,  after  the  latter 's  death,  was  assigned  to  the  duty 
of  making  the  necessary  dissections  and  anatomical  demon- 
strations before  the  class.  In  1565  he  was  appointed 
Professor  of  Surgery,  with  the  understanding  that  he  was 
to  continue  giving  his  demonstrations  in  anatomy.  The 
salary  which  he  received  for  this  double  work  was  100 
ducats,  but  it  was  increased  from  time  to  time  until  finally 
he  was  paid  1100  ducats  yearly.  At  the  end  of  thirty-six 
years  he  was  retired  upon  a  pension  of  1000  ducats  for  the 
remainder  of  his  life,  and  was  allowed  the  privilege  of 
appointing  his  successor  in  the  Chair  of  Surgery.  He  gave 
the  place  to  Julius  Casserius  in  1609.  To  distinguish 
him  from  another  Fabricius,  who  gained  great  distinction 
in  the  field  of  surgery,  it  has  always  been  customary  for 
later  historical  writers  to  speak  of  him  as  **  Fabricius  ab 
Acquapendente. "  His  namesake  is  known  as  ''Fabricius 
Hildanus. ' ' 

As  a  teacher  of  anatomy,  especially  in  its  relations  to 
physiology,  Fabricius  was  held  in  the  highest  esteem. 
Albert  von  Haller  speaks  of  him  as  being  one  of  the  glories 
of  the  Italian  school  of  medicine.  Pupils  came  in  flocks 
from  all  parts  of  Europe  to  attend  his  lectures,  and  among 
them  were  some  who,  like  William  Harvey  of  England, 
afterward  attained  great  celebrity  for  the  effective  work 
which  they  did  in  advancing  the  science  of  medicine.  One 
of  the  attractive  features  of  Fabricius'  teaching  was  to  be 
found  in  his  practice — something  quite  new  at  that  period — 
of  showing  to  the  students,  not  only  the  particular  organ 


352  GROWTH  OF  MEDICINE 

(human)  upon  which  he  happened  then  to  be  lecturing,  but 
also  the  corresponding  organ  in  one  or  several  of  the 
animals ;  thus  enabling  them  to  learn  what  were  the  features 
possessed  in  common  by  all  the  species,  and  what  were 
those  in  respect  of  which  the  species  differed.  As  time 
went  on,  the  number  of  those  who  came  to  witness  his 
anatomical  demonstrations  increased  so  greatly  that  he 
felt  impelled  to  build,  at  his  own  expense,  a  new  and  larger 
amphitheatre.  But  even  this,  in  a  short  time,  proved  to 
be  too  small,  and  then  the  Senate  at  Venice,  which  exercised 
a  governing  control  over  the  University  of  Padua,  erected 
(in  1593)  a  much  larger  and  more  complete  amphitheatre, 
upon  the  walls  of  which  there  was  placed  an  inscription 
stating  that  it  had  been  built  in  honor  of  Fabricius.  Among 
the  other  distinctions  which  were  conferred  upon  him  at 
this  time  he  was  raised  to  the  rank  of  Knight  of  the  Order 
of  Saint  Mark  and  made  an  honorary  citizen  of  Padua. 

Fabricius  ab  Acquapendente  added  to  our  stock  of 
anatomical  knowledge  by  his  researches  on  the  structure 
of  the  oesophagus,  stomach  and  intestines,  the  eye,  ear, 
larynx  and  foetus.  One  of  his  chief  claims  to  distinction, 
however,  rests  upon  the  fact  that  he  wrote  an  elaborate 
monograph  on  the  valves  of  the  veins.  Although  these 
structures  had  been  seen  and  described  at  an  earlier  date 
by  Charles  Estienne,  Berengarius,  Vesalius,  Cannani  and 
others  (Fra  Paolo  Sarpi,  for  example),  nobody  had  yet 
offered  a  satisfactory  explanation  of  their  probable  use 
or  had  traced  them  through  the  venous  system  at  large. 
In  1574  Fabricius  demonstrated  their  presence  in  all  the 
veins  of  the  extremities. 

But  Fabricius  ab  Acquapendente  was  not  merely  a  good 
anatomist  and  physiologist;  he  was  also  a  most  distin- 
guished surgeon  and  general  practitioner.  From  far  and 
from  near  patients  came  to  consult  him  about  their  ailments, 
and  he  appears  to  have  been  immensely  popular  among  all 
classes  of  the  community.  His  home,  situated  on  the  River 
Brenta,  just  outside  the  city  of  Padua,  was  most  attractive, 
and  it  was  there  that  he  dispensed  hospitality  in  a  princely 
fashion.    One  of  his  peculiarities  was  that  in  many  cases 


HUMAN  ANATOMY  AND  PHYSIOLOGY      353 

he  was  unwilling  to  accept  a  fee  for  his  services.  As  a 
natural  result,  gifts  of  all  sorts,  many  of  them  of  consid- 
erable value,  were  showered  upon  him.  He  devoted  one  of 
the  rooms  of  his  residence  to  the  purposes  of  a  cabinet  or 
museum,  in  which  all  those  gifts  which  were  suited  to  such 
display  might  be  properly  exposed  to  view,  and  over  the 
doorway  of  the  room  he  placed  this  inscription,  ^^Lucri 
neglecti  lucrum/^  which  I  venture  to  render  into  English 
by  the  following,  '*  Costly  gifts  representing  unproductive 
wealth. '  '^ 

Fabricius  remained  a  bachelor  all  his  life,  and  at  the  time 
of  his  death  (May  21,  1619,  at  the  age  of  eighty- two)  his 
fortune,  which  he  bequeathed  to  his  brother's  daughter, 
amounted  to  200,000  ducats — a  very  large  sum  in  those 
days. 

The  writings  of  Fabricius  were  published  at  Leipzig  in 
a  single  volume  in  1687,  but  Johann  Bohn,  who  edited  the 
collection,  omitted  the  different  prefaces  which  Fabricius 
had  written.  In  the  Leyden  edition  of  1737  this  defect  has 
been  remedied. 

To  furnish  here  even  a  much  abbreviated  account  of  the 
important  discoveries  made  in  anatomy  and  physiology 
during  the  sixteenth  century  would  call  for  a  much  larger 
amount  of  space  than  can  possibly  be  given  to  these  two 
branches  of  medical  science.  Our  modern  text  books  on 
the  subject  of  anatomy  alone  are,  in  a  certain  sense,  cata- 
logues of  these  very  discoveries,  and  every  physician  knows 
what  a  vast  amount  of  space  they  occupy.  I  have  already 
made  mention  of  a  few  of  these  discoveries,  and,  when  I 
come  to  consider  the  splendid  work  done  by  William  Harvey 
in  the  early  part  of  the  seventeenth  century,  I  shall  have 

2  The  meaning  of  this  Latin  inscription  can  best  be  appreciated  by  those 
physicians  who  have,  through  a  long  period  of  years,  practiced  their  profession 
largely  among  the  well-to-do  classes  of  a  metropolitan  city.  They  alone,  I 
believe,  would  understand  the  significance  of  "lucrum  neglectum"  as  applied 
to  a  large  proportion  of  the  gifts  which  a  practitioner  of  medicine  receives 
from  grateful  patients;  and  it  is  not  at  all  likely  that  a  layman  who  is  not 
familiar  with  this  aspect  of  a  physician's  life  would,  under  the  circumstances 
mentioned,  have  the  slightest  suspicion  that  the  device  quoted  above  could 
possibly  bear  the  meaning  that  I  have  given  to  it. 


354  GROWTH  OF  MEDICINE 

occasion  to  recapitulate  briefly  the  more  important  dis- 
coveries made  by  his  predecessors  in  this  particular  field. 
In  this  way  I  shall  be  able  to  supply  information  regarding 
several  of  the  discoveries  which  I  am  now  obliged  to  pass 
over  in  silence,  but  which,  under  other  circumstances,  would 
more  properly  receive  consideration  in  the  present  chapter. 


CHAPTER  XXVIII 

FURTHER  DETAILS  CONCERNING  THE  ADVANCE 
IN  OUR  KNOWLEDGE  OF  ANATOMY— DISSECT- 
ING MADE  A  PART  OF  THE  REGULAR  TRAINING 
OF  A  MEDICAL  STUDENT— lATROCHEMISTS 
AND  lATROPHYSICISTS— THE  EMPLOYMENT 
OF  LATIN  IN  LECTURING  AND  WRITING  ON 
MEDICAL  TOPICS 

Further  Details  Concerning  the  Advance  in  Our  Knowl- 
edge of  Gross  Anatomy. — In  the  preceding  chapter  I  have 
given  some  account  of  the  efforts  made  during  the  sixteenth 
century  by  certain  physicians  to  lay  solidly  the  foundations 
of  a  gross  anatomy  of  the  human  body.  The  time  was  ripe 
for  such  a  movement,  and  the  right  sort  of  men  took  charge 
of  it  and  pushed  it  forward  to  such  a  stage  of  successful 
accomplishment  that  we  physicians  of  to-day  are  able  to 
continue  in  the  direction  indicated,  and  under  the  impulse 
communicated,  by  these  master  builders.  These  men,  it 
should  be  remembered,  did  something  more  than  merely 
to  lay  solid  and  durable  foundations  in  the  form  of  an 
accurate  anatomy,  they  also  taught  the  correct  methods  of 
procedure  for  the  erection  of  the  superstructure  of  the 
science  of  medicine. 

Up  to  the  end  of  the  sixteenth  century  almost  all  the  work 
done  in  anatomy  was  effected  with  the  aid  of  the  scalpel 
alone,  the  object  being  to  isolate  and  expose  clearly  to  view 
the  larger  tissues  and  organs,  such  as  muscles,  arteries, 
veins,  nerves,  etc.  In  a  very  few  instances  mor^  elaborate 
methods  were  devised,  even  as  early  as  during  the  fifteenth 


356  GROWTH  OF  MEDICINE 

century,  by  men  of  exceptional  (Ueverness.  Thus,  for 
example,  in  1490,  Alexander  Benedetti,  Professor  of 
Anatomy  at  Padua,  invented  a  ibethod  of  preserving 
muscles,  nerves  and  blood-vessels  as  permanent  dry  speci- 
mens, and  it  is  said  that  he  sold  such  preparations  for  large 
sums  of  money.  As  already  stated  on  a  previous  page,  the 
injection  of  blood-vessels  with  certain  fluids  was  also 
employed  to  a  very  limited  extent  at  this  early  period  as 
a  means  of  distinguishing  them  more  easily  from  the 
surrounding  structures ;  but  this  practice  gave  place,  during 
the  seventeenth  century,  to  the  better  method  of  employing, 
as  an  injecting  material,  a  semi-fluid  preparation  which 
became  quite  solid  soon  after  it  had  penetrated  well  into 
the  interior  of  the  vessels,  and  to  which  any  desired  opaque 
color  might  be  given.  This  method  was  invented  by  the 
Hollander,  John  Swammerdam  (1627-1680)  and  perfected 
by  Van  Home.  It  was  largely  by  the  employment  of  this 
procedure  that  Friedrich  Ruysch  of  Amsterdam  (1638- 
1731),  Professor  of  Anatomy  and  Botany  in  the  university 
of  his  native  city,  gained  such  celebrity  throughout  Europe 
for  the  great  beauty  of  his  permanent  anatomical  prepara- 
tions. Hyrtl  mentions  the  fact  that  Peter  the  Great  of 
Russia,  who  resided  for  a  certain  length  of  time  at  Zaandam, 
near  Amsterdam,  in  order  that  he  might  familiarize  himself 
with  the  art  of  ship-building,  was  in  the  habit  of  visiting 
Ruysch  from  time  to  time  in  his  museum  and  laboratory; 
and  finally  (in  1717)  bought  from  him,  for  the  sum  of  30,000 
florins,  his  entire  collection  of  specimens,  together  with  the 
formula  of  the  mixture  which  he  employed  in  making  his 
injections.  The  collection  itself,  it  should  be  stated,  con- 
tained not  only  specimens  illustrative  of  normal  human 
anatomy  {e.g.,  the  various  solid  and  hollow  organs,  the 
organs  of  special  sense,  and  objects  belonging  to  the 
vascular,  muscular,  nervous  and  osseous  systems),  but 
also  many  specimens  illustrating  pathological  and  com- 
parative anatomy,  and  a  great  variety  of  monstrosities. 

Ruysch  also  attained  remarkable  success  in  restoring  the 
rosy  color  and  soft  flexibility  of  the  skin  and  the  natural 
facial  expression  in  certain  dead  bodies  by  the  employment 


ADVANCE  IN  KNOWLEDGE  OF  ANATOMY  357 

of  a  preservative  fluid  widely  known  as  ^^ Liquor  balsam- 
icus.'*^  Tradition  says  that  in  one  instance,  that  of  a  child 
whose  corpse  had  been  treated  in  this  manner  by  Enysch, 
the  face  presented  such  a  perfectly  life-like  appearance  that 
the  Czar,  as  he  passed  near  the  object,  thought  he  was 
looking  upon  a  sleeping  child  and  gave  it  a  kiss. 

The  aged  professor  lived  to  be  ninety-three,  and  con- 
tinued giving  his  lectures  on  anatomy  almost  up  to  the  day 
of  his  death,  which  resulted  from  accidental  injuries. 
When  it  became  clear  that  these  Avere  of  so  serious  a  nature 
that  he  could  not  possibly  recover,  he  asked  to  be  carried 
on  a  stretcher  into  the  assembly  room  in  order  that  he 
might  say  a  farewell  to  the  students  who  had  been  attending 
his  lectures. 

Although  some  critics  have  intimated  that  Ruysch  should 
be  ranked  merely  as  a  very  clever  mechanic  in  the  domain 
of  anatomy,  there  are  certain  well-established  facts  which 
show  that  this  estimate  of  the  man  is  unfair.  It  is  known, 
for  example,  that  he  was  the  first  anatomist  to  call  attention 
to  the  features  which  distinguish  the  male  from  the  female 
skeleton  {e.g.,  the  differences  in  the  form  of  the  pelvis  and 
of  the  thorax).  Ruysch  also  advanced  our  knowledge  of 
the  vascular  system  by  means  of  the  improvements  which 
he  effected  in  the  method  of  injecting  blood-vessels.  His 
skill  in  this  special  work  was  so  great  that  people  were 
wont  to  say  of  him  that  he  possessed  the  fingers  of  a  fairy 
and  the  eyes  of  a  lynx.  It  was  Ruysch  too  who  furnished 
the  first  descriptions  of  the  bronchial  blood-vessels  and  of 
the  vascular  plexuses  of  the  heart.  Finally,  the  term 
'^memhrana  Rupschiana,^'  in  connection  with  the  choroid 
of  the  eye,  bears  testimony  to  the  fact  that  he  was  also  an 
original  worker  in  this  very  difficult  corner  of  the  field 
of  human  anatomy. 

The  crowning  event  in  the  life  of  Ruysch — an  event  which 
shows  how  wasteful  many  of  us  men  are  of  our  productive 
powers  when  we  deliberately  retire  from  all  participation 
in  active  work,  physical  or  mental,  at  the  comparatively 
early  age  of  sixty-five — occurred  in  1717,  when  he  had 
attained  the  age  of  seventy-nine.     Peter  the  Great  had 


358  GROWTH  OF  MEDICINE 

hardly  left  the  premises  with  the  great  collection  of  speci- 
mens for  which  he  had  paid  such  a  fabulous  price,  when 
Ruysch  began  the  making  of  a  new  collection;  and  at  this 
task  he  worked  so  diligently  that  in  less  than  ten  years  he 
was  able  to  deliver  to  John  Sobieski,  King  of  Poland,  the 
greater  part  of  the  new  collection  (for  which  he  received 
the  sum  of  20,000  florins).  Then  followed  a  period  of 
about  three  years  during  which  he  continued  active  work 
as  a  teacher  of  anatomy,  death  alone  seeming  to  possess 
the  power  to  arrest  his  extraordinary  energy. 

Euysch's  only  published  works  are  the  following: 
Catalogue  of  the  Specimens  contained  in  his  Museum, 
Amsterdam,  1691;  and  a  Thesaurus  Anatomicus,  in  10 
volumes,  Amsterdam,  1701-1715. 

In  reading  over  the  account  which  I  have  given  of  the 
discoveries  made  in  gross  anatomy  and  in  physiology 
during  the  sixteenth  and  seventeenth  centuries,  I  find  that 
I  have  omitted  some  that  may  just  as  appropriately  be 
mentioned  in  this  section  as  in  that  which  I  intend  to 
devote  to  work  done  in  the  domain  of  minute  anatomy. 
I  shall  therefore  refer  to  them  briefly  now,  and  then  pass 
on  to  the  consideration  of  the  latter  branch  of  my  subject. 

Eustachius,  the  famous  Italian  anatomist,  deserves 
special  credit  for  the  experimental  methods  which  he 
devised  and  employed  in  his  efforts  to  gain  a  better  knowl- 
edge of  the  anatomy  and  physiology  of  the  kidneys. 
Moritz  Hofmann  of  Fiirstenwald  discovered  in  1641,  in  the 
turkey  gobbler,  the  outlet  duct  of  the  pancreas,  and  a  short 
time  afterward  George  Wjrsung,  a  Bavarian,  discovered 
the  same  structure  in  the  human  being.  Then,  in  1651, 
Olaus  Eudbeck,  Professor  of  Anatomy  in  the  University 
of  Upsala,  Sweden,  discovered  the  lymphatics  of  the 
intestines,  and  established  (at  a  later  date)  the  fact  that 
they  are  a  separate  system  from  that  of  the  chyle  ducts. 
Francis  Glisson  (1597-1677)  of  Cambridge  University, 
England,  one  of  Harvey's  pupils,  made  two  series  of 
anatomical  investigations  of  a  most  creditable  character — 
the  first  concerning  the  relationship  which  exists  between 
the  intestinal  lymphatics  and  the  alimentary  canal,  and  the 


ADVANCE  IN  KNOWLEDGE  OF  ANATOMY  359 

second  regarding  the  internal  construction  of  the  liver 
('' capsule  of  Glisson").  Thomas  Wharton  (1610-1673),  a 
native  of  Yorkshire,  England,  and  a  London  practitioner 
of  medicine,  discovered  the  outlet  channel  of  the  sub- 
maxillary salivary  gland,  now  known  as  ** Wharton's 
duct,"  and  he  also  published  the  first  exhaustive  treatise 
on  the  structure  of  glands  in  general  (thymus,  pancreas, 
submaxillary,  etc.)-  About  the  middle  of  the  seventeenth 
century  Nathanael  Highmore  of  Oxford,  England  (1613- 
1685),  discovered  and  adequately  described  the  cavity  in 
the  superior  maxilla  which  bears  his  name  (** antrum  of 
Highmore"),  and  which  in  comparatively  recent  years  has 
assumed  such  importance  from  the  viewpoint  of  the 
practical  surgeon.  A  Danish  anatomist,  who  is  known  to 
us  English-speaking  physicians  as  Nicholas  Steno  (1638- 
1686),  but  to  his  own  coWtrymen  as  Niels  Stensen,  dis- 
covered the  outlet  duct  of  the  parotid  gland  C  Steno 's 
duct").  Stephen  Blancaard  (1650-1702),  a  practicing 
physician  of  Amsterdam,  made  the  first  successful  injec- 
tions of  capillary  blood-vessels;  and  Domenico  de  Mar- 
chettis  (1626-1688),  Professor  in  the  University  of  Padua, 
employing  Blancaard 's  technique,  succeeded  in  proving 
that  the  finest  ramifications  of  both  veins  and  arteries 
communicate  the  one  with  the  other.  To  Conrad  Victor 
Schneider,  a  professor  at  the  University  of  Wittenberg, 
Germany  (1614-1680),  we  are  indebted  for  putting  an  end 
forever  to  the  erroneous  doctrine  that  the  nasal  mucus 
is  produced  in  the  brain.  He  did  not,  however,  have  the 
good  fortune  to  discover  the  glands  from  which  this  mucus 
actually  comes;  the  credit  for  this  discovery  being  due  to 
Niels  Stensen.  Among  the  host  of  other  successful  dis- 
coverers in  the  domain  of  anatomy  during  the  seventeenth 
century  the  following  men  deserve  at  least  to  be  mentioned 
by  name:  Johann  Conrad  Peyer  (1653-1712)  of  Schaff- 
hausen,  Switzerland;  Johann  Conrad  Brunner  (1653-1727), 
also  a  native  of  Switzerland;  Theodor  Kerckring  (1640- 
1693)  of  Hamburg,  Germany;  Anton  Nuck  (1650-1692), 
Professor  of  Anatomy  at  the  University  of  Leyden,  Hol- 
land;  Reignier   de    Graaf    (1641-1673),    a   native    of   the 


360  GROWTH  OF  MEDICINE 

Netherlands;  and  Thomas  Willis  (1622-1675)  and  William 
Cowper  (1666-1709),  both  of  them  Englishmen. 

And,  finally,  it  may  be  stated  that  all  the  leading  anat- 
omists of  the  sixteenth  century  devoted  a  great  deal  of  time 
to  the  study  of  the  manner  in  which  the  nerves  are  dis- 
tributed throughout  the  body  and  to  ascertaining  the 
arrangement  of  the  intracranial  and  intraspinal  nervous 
structures.  To  give  even  the  most  superficial  account  of 
what  these  men  accomplished  would  occupy  far  more 
space  than  can  well  be  spared  for  this  purpose.  Kurt 
Sprengel  is  my  authority  for  saying  that,  of  all  the  workers 
in  this  particular  field  during  the  period  in  question, 
Fallopius  is  entitled  to  receive  the  greatest  credit  for  what 
he  accomplished. 

The  First  Beginnings  of  Minute  or  Microscopic  Anat- 
omy.— The  anatomy  of  the  tissues — microscopic  anatomy — 
begins  with  Marcello  Malpighi  (1628-1694),  a  native  of 
Crevalcuore,  near  Bologna,  Italy.  It  is  not  positively 
known  who  was  the  inventor  of  the  compound  microscope. 
First  employed  about  the  year  1620,  the  instruments  of  this 
type  came  into  fairly  general  use  toward  the  middle  of  the 
seventeenth  century.  But  the  early  compound  microscopes 
were  not  very  satisfactory,  and  consequently  preference 
was  given,  for  a  long  time,  to  those  of  the  simple  type. 
Achromatic  instruments  were  not  purchasable  until  1780, 
when  the  famous  German  physicist,  Leonhard  Euler, 
succeeded  in  overcoming  the  obstacles  which  had  up  to  that 
time  stood  in  the  way  of  their  successful  manufacture. 

In  1661  Malpighi,  who  was  in  the  habit  of  manufacturing 
his  own  microscopes,  was  able,  by  aid  of  one  of  these 
instruments,  to  exhibit  the  blood,  loaded  with  its  corpuscular 
bodies,  passing  rapidly  from  one  capillary  vessel  to 
another  in  the  frog's  lung.  Then  in  1683  Guillaume 
Molyneux,  in  1690  Anton  van  Leeuwenhoek,  and  in  1697 
William  Cowper,  witnessed  the  same  phenomenon  in  warm- 
blooded animals.  Among  the  other  anatomists  of  this 
period  who  contributed  in  varying  degrees  to  our  knowl- 
edge of  the  minute  anatomy  of  the  different  tissues  and 
organs  the  following  deserve  to  be  mentioned:    J.  Riolan 


ADVANCE  IN  KNOWLEDGE  OF  ANATOMY  361 

(1577-1657),  Boselli  of  Naples  (1608-1679),  Lower  of 
Oxford,  England  (1631-1691),  Vesling  of  Minden,  Germany 
(1598-1649),  Regnier  de  Graaf  of  Delft,  Holland  (1641- 
1673),  who  gained  so  great  distinction  by  his  accurate 
description  of  the  ovarian  follicles  (*' Graafian  follicles") ; 
and  James  Douglas  (1676-1742),  the  English  anatomist, 
who  ascertained  and  described  the  precise  limits  of  the 
peritoneum. 

Of  all  the  men  whom  I  have  mentioned  above,  Malpighi 
and  Leeuwenhoek  are  probably  the  best  known  to  our 
readers  for  the  large  number  and  important  character  of 
the  contributions  which  they  made  to  microscopic  anatomy. 
The  list  of  Malpighi 's  achievements,  for  example,  includes 
the  following,  in  addition  to  the  demonstration  of  the  blood 
in  actual  circulation,  as  already  mentioned:  contributions 
to  our  knowledge  of  the  finer  structure  of  plants;  the 
demonstration  of  the  minute  anatomy  of  the  skin  {^Wete 
mucosum^^  or  ^^rete  Malpighi*^) ;  the  amplification  of  our 
knowledge  of  the  structure  of  the  teeth ;  the  discovery  that 
the  lungs  are  composed  to  a  large  extent  of  terminal 
vesicles,  the  walls  of  which  are  richly  supplied  with  blood- 
channels;  the  demonstration  that  certain  glands  possess 
an  acinous  structure  {i.e.,  an  outlet  channel  springing  from 
numerous  small  sacs,  the  whole  group  resembling  a  cluster 
of  grapes) ;  more  complete  details  regarding  the  structure 
of  the  spleen  and  the  kidneys  (''Malpighian  bodies  or 
corpuscles") ;  additions  to  our  knowledge  of  the  structure 
of  the  white  and  the  gray  substances  of  the  brain  and  the 
demonstration  that  fibres  from  the  spinal  cord  pass  on  into 
the  brain;  the  declaration  that  the  papillae  of  the  tongue 
are  organs  of  taste  and  the  papillae  of  the  skin  are  organs 
of  the  sense  of  touch;  and  not  a  few  other  contributions 
of  greater  or  less  importance.  During  his  long  life  Anton 
Leeuwenhoek  (1632-1723)  of  Delft,  Holland,  made  a  great 
many  additions  to  microscopic  anatomy,  some  of  the  more 
important  of  which  are  the  following:  he  was  the  first  to 
discover  and  to  describe  the  many  varieties  of  Infusoria 
(the  animalcules  found  in  stagnant  collections  of  water) ; 
to  him  is  also  due  the  credit  of  first  observing  the  faceted 


362  GROWTH  OF  MEDICINE 

arrangement  in  the  eyes  of  insects;  he  made  original 
investigations  into  the  origin  and  mode  of  development 
of  several  species  of  the  lower  organisms ;  he  was  the  first 
to  observe  the  canaliculated  mode  of  construction  in  bone, 
and  he  also  noted  the  existence  of  the  so-called  bone- 
corpuscles  (afterward  rediscovered  and  more  accurately 
described  by  Purkinje) ;  he  discovered  the  striated  condi- 
tion of  the  bundles  of  muscular  fibres,  and  was  also  the 
first  person  to  teach  the  doctrine  that  the  growth  of  muscles 
is  effected  by  an  enlargement  of  the  primitive  bundles  of 
fibres  and  not  by  a  multiplication  of  these  structures;  he 
taught  further  that  muscle-substance  consists  of  numberless 
small  spheres;  he  was  the  first  to  describe  the  crystalline 
lens  as  a  structure  composed  of  fibres  which  are  arranged 
in  layers  or  sheets;  in  association  with  Guillaume  Moly- 
neux  he  studied,  under  the  microscope,  the  speed  with 
which  the  blood-current  travels  in  the  blood-vessels;  he 
made  valuable  observations  on  the  nature  of  the  sperma- 
tozoa; and,  finally,  the  very  first  studies  in  bacteriology 
appear  to  have  been  made  by  Leeuwenhoek.  As  a  result 
of  his  discovery  of  *' round,  rod-shaped,  thread-like  and 
corkscrew-shaped  bacteria"  between  the  teeth  of  a  human 
being,  the  theory  was  set  forth  that  probably  many  diseases 
owe  their  origin  to  such  ** little  animals.'" 

The  same  idea,  as  will  be  shown  farther  on,  occurred  to 
the  distinguished  medical  practitioner  of  Verona,  Italy, — 
viz.,  Fracastoro, — one  hundred  years  earlier  (1546). 
Leeuwenhoek,  it  should  here  be  stated,  possessed  a  very 
great  advantage  over  his  rivals  in  the  field  of  minute 
anatomy,  for  he  was  in  the  habit  of  using,  in  his  investi- 
gations, microscopes  which  he  himself  had  made,  and  which 
magnified  from  160  to  270  diameters,  whereas  those  utilized 
by  the  others  were  capable  of  magnifying,  at  the  maximum, 
only  143  diameters.  While  a  large  part  of  the  work  which 
he  performed  shows  plainly  that  he  was  a  skilful  and 
careful  anatomist  and  endowed  with  good  mental  powers, 

1  See  F.  Loeffler :  ' '  Vorlesungen  uber  die  geschichtliche  Entwickelung  der 
Lehre  von  den  Bakterien,"  Leipzig,  1887,  Th.  1;  and  also  p.  310  of  Pusch- 
mann's  "Geschichte  des  Medieinischen  Unterrichts, "  Leipzig,  1889. 


ADVANCE  IN  KNOWLEDGE  OF  ANATOMY  363 

Leeuwenhoek  nevertheless  manifested  certain  mean  traits 
of  character.  Daremberg  says  that  these  **  consisted  in  his 
disposition  to  conceal  his  technical  methods  from  his 
associates,  and  in  his  jealousy  of  others — as  manifested, 
for  example,  toward  Leibnitz,  who  had  established  a  similar 
laboratory  for  research  work  in  minute  anatomy.  These 
traits  of  character  showed  that  fundamentally  he  was  not 
a  true  lover  of  science,  but  rather  an  artisan.  And  yet, 
with  all  these  faults,  he  does  not  appear  to  have  placed 
an  inordinately  high  value  upon  his  discoveries  or  to  have 
beei^  unreasonably  sure  of  the  correctness  of  his  conclu- 
sions." The  first  monograph  published  by  Leeuwenhoek 
bears  the  date  1673.  It  is  a  study  of  the  minute  anatomy 
of  the  bee's  sting.  He  was  the  first  to  declare  that  the  blood 
is  the  nutritive  fluid  par  excellence,  and  that  it  is  to  be 
found  in  the  entire  series  of  organisms  belonging  to  the 
animal  kingdom.  He  divided  blood  into  two  parts — the 
red,  or  the  solid  portion,  and  the  serum.  The  corpuscles 
which  float  in  the  serum  and  give  to  the  whole  fluid  its  red 
color,  are  called  by  him  *' particles, "  in  the  case  of  blood 
from  birds,  reptiles  and  fishes,  and  ''globules"  in  that  from 
quadrupeds.  He  employed  this  term  ** globules"  because 
he  believed  that  these  bodies  were  exactly  spherical  in 
shape.  According  to  Daremberg,  Leeuwenhoek 's  studies 
cover  the  entire  field  of  human  histology,  and  his  findings 
are  for  the  most  part  correct. 

The  Founding  of  Organizations  for  the  Advancement  of 
Medical  Science. — During  the  seventeenth  century  there 
were  formed  a  number  of  associations  which  had  for  their 
object  the  promotion  of  scientific  knowledge,  and  these 
organizations  contributed  greatly  to  stimulate  original 
researches  in  anatomy  and  physiology  and  to  secure 
accuracy  in  the  published  results.  Perhaps  the  most 
important  institution  of  this  kind  was  the  French  Academic 
des  sciences,  which  was  founded  in  1666,  and  which  deserves 
the  credit  of  having  taken  a  very  important  part  in  the 
perfecting  of  our  knowledge  of  anatomy  and  physiology. 
The  Royal  Society  of  London,  founded  in  1645,  possesses 
a  splendid  record  of  valuable  work  accomplished.     The 

/ 


364  GROWTH  OF  MEDICINE 

following  organizations  also  deserve  to  be  honorably  men- 
tioned in  this  place:  the  Accademia  del  Lincei  at  Rome, 
founded  in  1603 ;  the  Academie  des  Curieux  de  la  Nature, 
1652 ;  and  the  Accademia  del  Cimento,  founded  at  Florence 
in  1657.    New  universities  were  also  founded  in  Germany. 

During  the  second  half  of  the  seventeenth  century  there 
were  three  French  physicians  who  deserve  credit  for  the 
excellence  of  the  work  which  they  did  in  the  departments 
of  anatomy  and  physiology,  viz.,  Vieussens,  du  Verney  and 
Dionis. 

i  ■'Raymond  Vieussens  (1641-1716),  a  native  of  Rovergue, 
was  Professor  of  Anatomy  at  the  University  of  Mont- 
pellier,  in  Southern  France.  Some  idea  of  the  extraordi- 
nary industry  displayed  by  this  anatomist  may  be  gained 
from  the  fact  that  he  is  credited  with  having  dissected 
more  than  five  hundred  bodies.  His  more  important 
published  works  relate  to  the  heart,  the  nervous  system 
and  the  structures  of  the  organ  of  hearing.  Pagel  speaks 
of  him  as  being  entitled  to  the  name  of  founder  of  the 
pathology  of  diseases  of  the  heart. 

Jean  Guichard  du  Verney  (1648-1730),  who  held  the 
Chair  of  Anatomy  in  the  University  of  Paris,  gained  a  large 
part  of  his  fame  as  an  anatomist  from  the  excellence  of 
his  investigations  into  the  complicated  structures  of  the 
internal  ear. 

Pierre  Dionis,  who  died  in  1718,  was  Demonstrator  of 
Anatomy  and  Surgery  at  the  Jardin  du  Roi  in  Paris  during 
the  latter  part  of  the  seventeenth  century  and  early  part 
of  the  eighteenth.  In  1690  he  published  a  treatise  on 
anatomy  which  remained  the  standard  book  on  this  subject 
for  a  number  of  years.  In  course  of  time  it  was  translated 
into  the  Latin,  English,  German  and  Chinese  languages. 

Dissecting  Made  a  Part  of  the  Regular  Training  of  a 
Medical  Student. — The  opportunities  for  dissecting  human 
bodies  varied  greatly  in  different  parts  of  Europe  during 
the  period  of  which  I  am  now  treating.  Vieussens,  as 
we  have  just  seen,  dissected  no  fewer  than  five  hundred 
bodies  during  his  long  professorship  at  Montpellier;  and 
Joseph  Lieutaud,  Professor  of  Anatomy  at  Paris,  dissected 


ADVANCE  IN  KNOWLEDGE  OF  ANATOMY  365 

more  than  twelve  hundred  bodies  during  the  continuance 
of  his  connection  with  that  institution.  So  far  as  I  have 
been  able  to  learn  from  my  examination  of  the  literature, 
the  professors  and  their  immediate  oflScial  assistants  were 
the  only  persons  who  had,  up  to  this  time,  derived  the 
principal  benefits  that  flow  from  work  of  this  nature;  the 
students  merely  listened  to  the  instructor's  remarks  upon 
the  objects  which  had  previously  been  exposed  to  view  by 
dissection.  But  toward  the  end  of  the  period — a  little  \ 
before  or  shortly  after  the  beginning  of  the  eighteenth 
century — facilities  were  provided  in  some  of  the  medical 
schools,  and  before  long  in  all  of  the  leading  ones,  for  the 
students  themselves  to  participate  in  this  highly  important 
part  of  a  physician 's  education.  The  value  of  such  training 
was  emphasized  by  the  statement  made  by  the  English 
philosopher,  John  Locke  (1632-1704),  toward  the  end  o*f  his 
life,  viz.,  that  all  human  understanding  is  based  upon 
experience.  He  wrote  that  at  birth  the  human  soul  is  like 
a  clean  sheet  of  paper  upon  which  all  the  objects  perceived 
by  the  senses  are  recorded  as  experiences,  and  there  they 
remain  until  by  the  aid  of  reflexion — i.e.,  by  the  aid  of  the 
understanding,  which  Locke  calls  the  inner  sense — they  are 
combined  into  conceptions  or  ideas.  Locke,  it  should  be 
remembered,  was  educated  as  a  physician,  but  he  never 
took  his  degree,  nor  did  he  ever  practice  medicine. 

The  first  stimulating  effects  of  the  Renaissance  upon  the 
devotees  of  the  science  of  medicine  were  felt  in  Italy  toward 
the  end  of  the  fifteenth  century,  and  these  effects  rapidly 
gained  in  intensity  during  the  following  century.  First 
France  and  afterward  Switzerland,  Belgium,  Holland  and 
England  were  almost  simultaneously  brought  under  the 
same  influence;  and  in  all  these  countries  the  students 
manifested  a  remarkable  eagerness  to  acquire  all  the 
knowledge  they  possibly  could.  In  Germany,  however,  the 
influence  of  the  Renaissance  did  not  make  itself  felt  until 
a  much  later  date,  and  the  thirst  for  knowledge  was  very 
much  slower  in  developing  than  was  the  case  in  any  of  the 
other  countries  mentioned.  Thus  Puschmann,  in  his 
** History   of   Medical   Education,"   makes   the   following 


366  GROWTH  OF  MEDICINE 

statement  which  shows  clearly  that  in  Germany  the  univer- 
sity students  of  that  period  must  have  been  a  very  rough 
set  of  men:  ''In  1625  the  Senate  of  the  University  of 
Leipzig  was  obliged  to  warn  its  students  that  they  must 
cease  disturbing  wedding  festivals  and  handling  the  guests 
roughly,  that  they  must  no  longer  make  obscene  remarks 
to  married  women  and  maidens,  etc.  And  in  1631  a  physi- 
cian named  Lotichius,  in  writing  to  a  friend,  made  the 
statement  that  'in  our  German  high  schools  the  students 
seem  to  prefer  strife  to  the  reading  of  books,  daggers  to 
copy-books,  swords  to  pens,  bloody  encounters  to  learned 
discussions,  incessant  boozing  and  noisy  reveling  to  the 
quiet  pursuit  of  their  studies,  and  public-houses  and 
brothels  to  students'  work-rooms  and  libraries.'  "  In 
1660  the  students  at  Jena,  on  one  occasion,  carried  on  a 
regular  battle  with  the  police,  and  as  a  result  of  this 
encounter  several  persons  were  killed.  In  the  light  of  this 
evidence,  therefore,  it  is  not  surprising  that  the  science 
of  medicine  made  comparatively  little  advance  in  Germany 
until  after  the  eighteenth  century  was  reached. 

latrochemists  and  latrophysicists. — During  the  seven- 
teenth century  there  was  a  great  deal  of  disputing  among 
physiologists  about  the  nature  of  certain  processes  like 
assimilation  and  retrograde  metamorphosis,  about  the 
manner  in  which  blood  is  formed,  about  digestion,  and  about 
the  role  played  by  the  lymph  vessels.  According  to  Haeser 
a  large  proportion  of  the  physicians  of  that  day  were 
confident  that  chemistry  was  entirely  competent  to  solve 
these  riddles,  and  yet,  on  the  other  hand,  there  were  not  a 
few  who  believed  that  the  science  of  physics,  which  was 
then  much  further  advanced  than  that  of  chemistry,  was 
quite  as  competent  to  explain  all  the  phenomena.  At  first 
the  split  into  these  two  factions  was  confined  to  men  who 
were  interested  in  questions  of  a  purely  physiological 
nature,  but  in  a  short  time  the  practitioners  of  medicine 
were  also  drawn  into  the  controversy;  and  from  that 
time  onward  it  became  customary  to  employ  the  terms, 
" latrochemists"  and  "latrophysicists"  in  speaking  of  the 
partisans  of  the  two  schools  of  medicine  (the  iatrochemical 


ADVANCE  IN  KNOWLEDGE  OF  ANATOMY  367 

and  the  iatrophysical  or  iatromeclianical).  The  iatro- 
chemists  described  digestion  as  an  act  that  is  essentially 
chemical  in  character,  a  form  of  fermentation;  and  by  the 
latter  term  the  more  advanced  members  of  this  school — 
Francois  Deleboe  Sylvius  (1614-1672),  who  was  born  in 
Hanau,  Prussia,  of  Dutch  parents,  and  who  took  his 
doctor's  degree  in  Basel  in  1637,  and  Thomas  Willis  of 
London  (1622-1675) — understood  something  quite  different 
from  our  modern  conception  of  fermentation.  Their  inter- 
pretation was  as  follows :  ' '  An  internal  chemical  movement 
of  nlatter  which  is  set  agoing  and  continued  in  action  in  the 
stomach  and  intestinal  canal  through  the  agency  of  certain 
chemical  reagents. "  (Haeser.)  They  attributed  an  impor- 
tant influence  to  the  salivaT,  the  pancreatic  juice  and  the 
bile  in  effecting  the  changes  mentioned.  The  iatro- 
physicists,  on  the  other  hand,  and  more  particularly 
Archibald  Pitcairn  of  Edinburgh,  Scotland  (1652-1713), 
and  Giorgio  Baglivi  of  Eagusa,  Italy  (1668-1707),  described 
digestion  as  a  purely  mechanical  breaking  up  of  the  ele- 
ments of  the  food  partaken — a  ''trituration."  As  to  the 
further  fate  of  the  resulting  chyle  (its  mode  of  reaching 
the  blood,  for  example)  the  two  schools  were  in  perfect 
accord. 

Sprengel  mentions  it  as  an  actual  fact  that,  during  the 
seventeenth  century,  there  were  several  physicians  who 
combined  the  two  careers  of  teacher  of  medicine  and 
hydraulic  engineer  (iatrophysicists  or  iatromathemati- 
cians).^  Several  events  conduced  to  the  formation,  in 
Italy  and  in  Great  Britain,  of  a  distinct  iatromathematical 
school.  Among  them  may  be  mentioned,  first  and  foremost, 
Harvey's  discovery  of  the  circulation  of  the  blood;  second, 
the  spread  of  the  doctrines  taught  by  Descartes  favored 
in  a  marked  degree  the  union  of  medicine  and  mathematics 
(physiology,  the  iatromathematicians  claimed,  was  only  a 
branch  of  applied  mathematics) ;  and,  third,  the  formation 
at  Florence,  in  the  middle  of  the  seventeenth  century,  of 
an  association  of  the  pupils  of  Galileo.    The  objects  of  this 

2  The  iatrophysicists  and  the  iatromathematicians  constituted  apparently 
two  kindred  branches  of  the  same  school. 


368  GROWTH  OF  MEDICINE 

association  were  to  cultivate  their  master's  philosophy, 
to  carry  on  the  work  of  experimental  physics,  and  to  apply 
its  principles  in  every  department  of  natural  science. 
Alphonso  Borelli  (1608-1679),  Professor  of  Mathematics 
first  at  Messina  and  afterward  at  Pisa,  the  author  of  the 
famous  treatise  on  ' '  The  Movements  of  Animals, ' '  and  the 
founder  of  the  iatromathematical  school,  was  a  member 
of  the  association.  In  this  connection  it  is  important  to 
mention  another  zealous  worker  in  the  field  of  iatro- 
mathematics,  viz.,  Sanctorius  Sanctorinus,  of  Capo  d'Istria 
(1561-1636).  His  work  was  done  quite  independently 
of  any  general  movement  among  scientific  investigators 
and  at  a  much  earlier  period  than  that  during  which  the 
school  flourished.  He  was  quite  successful,  for  example, 
in  his  attempts  to  measure  the  actual  amount  of  impercep- 
tible evaporation,  and  to  determine  the  influence  which  this 
process  exerts  upon  health  and  disease.  In  the  course  of 
these  investigations  in  what  he  called  ''static  medicine," 
Sanctorinus  invented  a  number  of  unusual  instruments. 

The  phenomenon  of  the  formation  of  schools  or  sects, 
the  members  of  which  were  keenly  interested  in  the  mainte- 
nance and  promulgation  of  certain  physiological,  patho- 
logical, or  therapeutic  doctrines,  manifested  itself  anew, 
as  I  have  shown  above,  in  the  seventeenth  century.  In 
the  early  years  of  the  Christian  era  the  partisans  of 
different  medical  doctrines  formed  schools  of  this  nature 
which  flourished  for  a  certain  period  of  time  and  then  died 
out  completely.  Such,  for  example,  were  the  sects  of  the 
Dogmatists,  the  Methodists,  the  Pneumatists,  etc.  The 
mere  fact  of  the  existence  of  these  different  schools  or  sects 
showed  unmistakably  that  the  science  of  medicine  was  alive 
at  that  time  and  that  its  devotees  were  making  vigorous 
efforts  to  increase  their  stock  of  knowledge.  Then  followed 
the  long  period  of  the  Middle  Ages,  a  series  of  many  cen- 
turies, during  which  medicine  made  only  slight  gains ;  but 
at  last  came  the  Renaissance, — the  fifteenth,  sixteenth  and 
seventeenth  centuries, — and  here  again  we  have  a  recur- 
rence of  the  same  phenomenon  of  sects  in  medicine;  but 
note  the  great  difference  between  the  earlier  manifestations 


ADVANCE  IN  KNOWLEDGE  OF  ANATOMY  369 

-and  those  which  I  have  just  outlined.  The  present  group, 
it  is  proper  to  remark,  is  merely  the  forerunner  of  several 
similar  movements  that  are  to  occur  during  the  eighteenth 
and  nineteenth  centuries,  movements  that  are  all  based,  in 
varying  degrees,  upon  the  truth. 

The  Employment  of  Latin  in  Lecturing  and  Writing  on 
Medical  Topics.— Ija-^  the  countries  of  Europe,  but  more 
particularly  in..6^many,  there  existed  during  the  sixteenth 
and  sevenWnth  centuries — and  for  a  long  time  subse- 
quently—t;he  practice  of  delivering  all  the  lectures  on 
medicajktopics  in  the  Latin  tongue — i.e.,  in  a  language 
whi^lkat  best  could  not  be  easily  understood  by  more  than 
a  small  proportion  of  the  students.  Even  the  lecturers 
themselves  must  have  been  hampered  in  the  full  expression 
of  their  thoughts  by  this  rule,  which  was  practically 
compulsory.  Paracelsus  (1493-1534),  the  famous  Swiss 
physician,  tried — a  full  century  earlier,  as  will  be  shown 
farther  on — to  break  up  this  seemingly  harmless  but  in 
reality  objectionable  custom;  his  example,  however,  was 
not  followed,  and  the  practice  was  continued  without 
interruption  for  at  least  two  centuries  longer.  The  use 
of  Latin  as  the  language  in  which  all  medical  knowledge 
was  to  be  taught  was  undoubtedly  based  upon  the  idea  that 
it  was  necessary  for  the  educated  physician  to  be  reason- 
ably familiar  with  that  particular  tongue,  for  the  simple 
reason  that  it  was  the  only  one  in  which,  in  those  early  days 
in  "Western  Europe,  the  writings  of  Galen  were  accessible, 
for  nobody  but  a  few  expert  scholars  had  yet  acquired  any 
useful  knowledge  of  Greek,  the  language  in  which  all  of 
Galen's  works  were  originally  written.  But  it  is  quite 
likely  that  with  this  motive,  which  certainly  was  intended 
to  produce  good  and  useful  fruit,  there  was  coupled  the 
further  idea  that  the  great  mass  of  irregular  practitioners — 
the  quacks,  the  early  barber-surgeons  (Wundaerzte),  and 
the  peripatetic  physicians — would  in  this  way  be  debarred 
from  entering  the  ranks  of  the  regularly  trained  physicians. 
It  was  only  after  the  custom  of  using  the  Latin  for 
lecturing  and  writing  purposes  had  become  thoroughly 
rooted  in  the  minds  of  medical  men  as  something  right  and 


370  GROWTH  OF  MEDICINE 

proper,  that  it  began  to  dawn  upon  the  minds  of  some  of 
the  brighter  men  that  this  practice  was  harmful  to  the 
advance  of  medicine  beyond  the  standards  established  by- 
Galen.  Vesalius,  who  was  a  contemporary  of  Paracelsus, 
fully  appreciated  how  serious  an  obstacle  to  further 
progress  in  anatomical  knowledge  the  teachings  of  Galen 
were,  and  it  was  he  who  made  the  first  really  successful 
attack  on  this  great  hindrance  to  further  progress;  but 
there  is  no  evidence  to  show  that  he  had  the  slightest  idea 
that  lecturing  and  writing  about  medical  topics  in  Latin 
played  any  part  in  the  perpetuation  of  the  evil  which  he 
was  fighting.  To  Paracelsus  alone  belongs  the  credit,  so 
far  as  I  know,  of  endeavoring,  through  the  force  of  example 
and  by  spoken  arguments,  to  break  up  the  practice  which 
we  are  here  considering.  I  may  be  mistaken  in  the  view 
which  I  have  here  expressed,  but  it  is  difficult  for  me  not 
to  believe  that  the  habitual  use  of  Latin  as  the  proper 
vehicle  for  the  transmission  of  facts  and  ideas  belonging 
to  the  domain  of  medicine  must  have  materially  hindered 
the  advancement  of  that  science;  for  such  use  certainly 
tended  to  keep  men's  minds  moving  in  fixed  ruts,  and  those 
ruts  all  led  straight  toward  the  faulty  teachings  of  Galen. 


CHAPTER  XXIX 

THE  CONTEIBUTIONS  MADE  BY  DIFFERENT  MEN 
DURING  THE  RENAISSANCE,  AND  MORE  PAR- 
TICULARLY BY  WILLIAM  HARVEY  OF  ENG- 
LAND, TO  OUR  KNOWLEDGE  OF  THE  CIRCULA- 
TION OF  THE  BLOOD,  LYMPH  AND  CHYLE 

Among  the  earliest  known  doctrines  relating  to  the 
nature  of  the  blood  and  its  mode  of  distribution  throughout 
the  body  are  those  attributed  to  Erasistratus  and  Galen; 
for  the  still  more  ancient  ones,  of  which  Diogenes  of 
ApoUonia,  Aristotle  and  the  Hippocratic  writers  are 
reputed  to  be  the  authors,  are  too  incomplete  to  call  for 
serious  consideration  in  this  place. 

(a)  The  Doctrine  Taught  by  Erasistratus. — Erasis- 
tratus, who  was  born  at  Julis  in  the  Island  of  Ceos  (Aegean 
Sea)  during  the  third  century  before  Christ,  held  the  belief 
that  the  arteries  contain  only  air,  which  is  drawn  into  the 
lungs  by  way  of  the  trachea  and  bronchi,  whence  it  enters 
the  pulmonary  vein  (called  by  him  the  ** venous  artery"). 
In  its  further  course  this  air  passes  from  the  pulmonary 
vein  into  the  left  ventricle  of  the  heart,  and  is  then  conveyed 
from  that  organ  through  the  arteries  to  the  different  tissues 
of  the  body.  Erasistratus  further  taught  that  the  smallest 
subdivisions  of  both  the  arteries  and  the  veins  lie  side  by 
side  in  the  tissues,  and  that,  in  certain  abnormal  bodily 
conditions,  they  communicate  the  one  with  the  other 
through  anastomoses;  but  that,  in  a  normal  condition  of 
the  body,  no  communication  takes  place  between  the  two. 
In  common  with  all  other  physicians  of  that  time,  he 
believed  that  only  the  veins  carry  blood.     Here,  then,  we 


372  GROWTH  OF  MEDICINE 

find  the  first  glimmering  of  the  truth  with  regard  to  the 
nature  of  the  circulating  medium  and  also  with  regard  to 
the  course  which  it  pursues  in  one  part  of  its  circuit — that 
part,  namely,  where  the  two  kinds  of  vessels  become 
capillary  in  character.  His  substitution  of  air  for  blood 
in  the  arteries  is  plainly  the  principal  error  in  his  scheme. 

(6)  The  Teaching  of  Galen  and  of  Caesalpinus  with 
Regard  to  the  Nature  of  the  Blood  and  Its  Mode  of  Dis- 
tribution.— Galen,  in  the  second  century  of  the  present  era, 
disputed  the  correctness  of  the  doctrine  taught  by  Erasis- 
tratus.  His  objections  are  thus  stated:  ''Inasmuch  as 
blood  flows  from  an  artery  when  it  is  wounded,  one  of  two 
things  must  be  the  truth.  Either  blood  was  already  con- 
tained in  the  vessel  before  it  was  wounded,  or  it  must  have 
found  its  way  in  from  the  outside.  But,  if  the  blood  comes 
from  the  outside  into  a  vessel  which  contains  only  air,  then 
air  must  necessarily  escape  from  that  vessel  (when 
wounded)  before  blood  does — which  is  contrary  to  the  fact, 
as  blood  alone  flows  out.  Therefore  arteries  contain  only 
blood."  As  a  further  proof  of  the  correctness  of  his 
statement  Galen  carried  out  the  following  experiment: 
In  a  living  animal  he  placed  two  ligatures  around  an  artery 
at  points  situated  not  far  apart,  and  then  made  an  opening 
in  the  vessel  between  the  two  ligatures.  The  intervening 
section  of  the  artery,  it  was  thus  found,  contained  only 
blood.  This  experiment,  it  might  reasonably  be  supposed, 
would  have  definitely  settled  the  question;  but  such  was 
not  the  case.  The  followers  of  Erasistratus  immediately 
raised  this  objection:  If  the  arteries  contain  blood,  how 
may  the  air  which  is  drawn  into  the  lungs  find  its  way  to 
all  parts  of  the  body?  Galen  replied  that  the  inhaled  air 
does  not  pass  through  the  lungs,  but  is  rejected  by  them 
after  it  has  cooled  the  blood.  This  refrigerating  process, 
he  claimed,  constitutes  the  sole  purpose  of  the  respiratory 
act. 

Although  Galen's  idea  regarding  the  true  function  of 
respiration  is  not  in  harmony  with  the  doctrine  taught  by 
modern  physiologists,  it  nevertheless  represents  a  marked 
advance  over  the  belief  previously  maintained.     Even  as 


CIRCULATION  OF  TEE  BLOOD  373 

recently  as  in  the  time  of  Albert  von  Haller  (approximately 
1760-1780)  physicians  still  continued  to  believe  that  it  was 
the  function  of  respiration  to  cool  the  blood;  and  indeed 
it  was  scarcely  possible  before  1800  to  offer  a  more  correct 
physiology  of  the  act  of  breathing,  for  it  was  not  until 
after  the  lapse  of  many  centuries  that  the  advance  in  our 
knowledge  of  chemistry  reached  a  point  at  which  it  became 
possible  to  find  a  satisfactory  solution  of  so  complicated 
a  problem. 
V  As  to  the  nature  of  the  blood  itself  Galen  believed,  as  I 
have  already  stated  more  fully  in  Part  I.  (*' Ancient 
Medicine"),  that  there  are  two  kinds — spirituous  blood 
(or  /spirit)  and  venous  blood.  He  gave  the  name  of 
spirituous  blood  to  that  which  is  found  circulating  in  the 
arteries,  and  which  is  appreciably  brighter  in  color  than 
that  which  fills  the  veins.  According  to  Flourens,  the 
distinguished  French  physiologist  of  the  nineteenth  cen- 
tury, Galen  was  the  first  among  the  ancient  anatomists  to 
make  this  distinction  of  two  different  kinds  of  blood.  To 
the  spirituous  variety  Galen  ascribed  the  function  of 
nourishing  the  more  delicately  constructed  organs  like  the 
lungs,  while  he  claimed  that  the  venous  blood  is  suited  to 
nourish  only  the  coarser  ones,  like  the  liver,  spleen,  etc. 

In  his  further  development  of  a  physiology  of  the 
circulation  of  the  blood  Galen,  who  as  a  rule  expresses  his 
ideas  with  great  clearness,  makes  statements  which  I  find 
it  extremely  difficult  to  comprehend.  I  am  therefore 
tempted  to  assume  that  the  copyists,  to  whom  we  are 
indebted  for  handing  down  his  actual  words  from  age  to 
age,  are  the  persons  upon  whom  should  be  cast  the  blame 
for  the  obscurity  of  which  I  complain.  However  this  may 
be,  it  is  an  unquestionable  fact  that  the  ablest  physiologists, 
were  they  to  be  confronted  to-day  with  the  duty  of  solving 
this  problem  of  the  circulation  under  the  conditions  of 
knowledge  which  existed  during  the  third  century  of  our 
era,  would  surely  not  be  able  to  provide  a  more  correct 
solution  than  that  which  is  credited  to  Galen.  The  problem 
was  attacked  repeatedly  by  some  of  the  brightest  and  best- 
equipped  minds  of  the  Renaissance  period,  but  not  one  of 


374  GROWTH  OF  MEDICINE 

these  exceptionally  clever  men  was  able  to  offer  an  entirely- 
acceptable  solution.  Harvey  alone,  as  will  appear  farther 
on  in  this  account,  solved  the  riddle  once  and  for  all. 

The  ^'spirit" — the  purest  part  of  the  blood — is  lodged, 
according  to  Galen,  in  the  left  ventricle ;  and,  inasmuch  as 
even  the  venous  blood,  if  it  is  to  fulfil  in  some  degree  the 
function  of  a  nourishing  fluid,  must  possess  a  certain 
proportion  of  ** spirit,"  it  is  clear  that  the  two  ventricles 
should  communicate  the  one  with  the  other ;  for  how  other- 
wise— thought  Galen — is  it  possible  for  a  certain  amount 
of  ** spirit"  to  commingle  with  the  venous  blood?  The 
locality  at  which  this  communication  was  assumed  to  exist 
was  the  interventricular  septum;  and,  as  nobody  was  able 
to  find  anything  like  a  foramen  in  this  membrane,  it  was 
asserted  that  the  communication  is  effected  through  an 
infinite  number  of  pores.  For  over  one  thousand  years 
physicians  accepted  this  porous  character  of  the  inter- 
ventricular septum  as  an  established  fact.  In  his  com- 
mentaries on  Mondino's  ''Anatomy"  (1521),  Berengarius 
of  Carpi  timidly  ventured  the  statement  that  the  openings 
of  communication  are  not  distinctly  visible,  and  this  appar- 
ently was  the  first  feeble  expression  of  doubt  concerning 
the  correctness  of  the  prevailing  doctrine.  Vesalius,  on 
the  other  hand,  boldly  denied  their  existence  altogether. 

According  to  Galen's  teaching  the  liver  is  the  source 
of  origin  of  all  the  veins,  just  as  the  heart  is  the  starting- 
point  of  all  the  arteries.  It  is  quite  remarkable,  says 
Flourens,  that  physicians  who  performed  almost  daily  the 
operation  of  venesection  should,  during  a  long  series  of 
years,  have  failed  to  observe  that  this  doctrine  of  blood 
flowing  through  the  veins  from  the  liver  to  the  different 
parts  of  the  body,  could  not  possibly  be  true,  inasmuch  as 
at  each  such  operation  the  vein  always  became  distended 
with  blood  below  {i.e.,  on  the  distal  side  of)  the  ligature 
which  they  applied  to  the  part  (arm,  for  example)  before 
opening  the  vessel.  This  phenomenon,  of  course,  indicated 
clearly  that  the  blood  in  the  veins  flowed  toward  the  heart, 
and  not  from  any  centrally  located  spot  or  organ  toward 
the  extremities.    And  yet — he  adds — even  so  bright  and 


CIRCULATION  OF  TEE  BLOOD  375 

thoughtful  a  man  as  Vesalius  does  not  appear  to  have 
noticed  this  fact.  Andreas  Caesalpinus  (1519-1603),  on 
the  other  hand,  did  observe  and  correctly  interpret  the 
phenomenon;  and  he  made  the  further  observation  that 
physicians  were  habitually  applying  the  ligature  above  the 
spot  which  they  expected  to  bleed,  regardless  of  the  fact 
that  in  so  doing  they  were  not  acting  in  harmony  with  their 
belief  concerning  the  circulation  of  blood  in  the  veins. 
Caesalpinus  also  states,  in  one  part  of  his  writings,  that 
''the  blood,  carried  to  the  heart  by  the  veins,  receives  in 
that  organ  its  last  transformation  toward  perfection, 
and  is  then — in  this  perfected  state — transported  by  the 
arteries  to  the  remotest  parts  of  the  body."  So  far  as  it 
relates  to  the  general  movement  of  the  blood  this  statement 
is  correct,  but  it  errs,  as  will  be  shown  presently,  in  men- 
tioning the  heart  as  the  locality  where  the  perfecting 
process  takes  place.  In  his  final  remarks  regarding  the 
anatomical  relations  which  exist  in  the  two  chambers  of 
the  heart  Caesalpinus  makes  the  following  statement: — 

Each  ventricle  possesses  two  vessels — one  through  which  the 
blood  reaches  that  chamber,  and  a  second  one  which  serves  to  carry 
it  out  of  the  ventricle.  The  vessel  through  which  the  blood  enters 
the  right  ventricle  is  called  the  vena  cava,  and  that  by  which  it 
leaves  this  same  chamber  is  called  the  pulmonary  artery.  The 
vessel  through  which  the  blood  arrives  in  the  left  ventricle  is  called 
the  pulmonary  vein,  and  that  through  which  it  leaves  this  left 
chamber  of  the  heart  is  known  as  the  aorta. 

The  Circulation  of  the  Blood  as  Elucidated  hy  Michael 
Servetus. — Michael  Servetus,  a  native  of  Villanueva,  Spain, 
who  in  1553  was  burned  alive  at  the  stake  near  the  city  of 
Geneva,  Switzerland,  because  of  his  heretical  teachings,  is 
not  infrequently  mentioned  as  the  individual  to  whom  credit 
is  due  for  having  furnished  the  first  description  of  the 
lesser  or  pulmonary  circulation.  There  is  no  question 
whatever  regarding  the  justice  of  according  to  him  at 
least  a  part  of  this  honor,  but  one  should  be  careful  to 
specify  that  Servetus  is  entitled  only  to  the  credit  of  having 
been  the  first  to  teach  that  the  blood,  in  its  journey  from 


376  GROWTH  OF  MEDICINE 

the  right  to  the  left  side  of  the  heart,  must  pass  entirely- 
through  the  lungs.  So  far,  his  doctrine  is  correct;  but 
he  also  taught  at  the  same  time  that  the  fluid  which  enters 
the  aorta  from  the  left  ventricle  is  not  blood  but  perfected 
''vital  spirit"  (Galen),  and  that  it  becomes  genuine  blood 
only  after  it  has  tarried  for  a  few  brief  instants  in  the 
ventricular  chamber  and  has  there  been  subjected  to  some 
unknown  influence  exerted  by  the  heart  itself.  This  second 
erroneous  part  of  Servetus'  description  seems  to  me  to 
diminish  very  materially  the  credit  to  which  he  is  otherwise 
entitled ;  and  I  cannot  help  feeling  that  Dezeimeris  is  right 
when  he  claims  that  Realdus  Columbus,  whose  more  perfect 
account  of  the  lesser  circulation  was  written  only  a  little 
later  than  that  of  Servetus,  is  perhaps  better  entitled  to 
the  honor  in  question. 

It  is  an  interesting  fact  that  Servetus  introduces  his 
disquisition  on  the  circulation  of  the  blood  in  the  very  midst 
of  a  treatise  which  bears  the  title  ''Restitution  of  Chris- 
tianity, ' ' — in  other  words,  in  a  treatise  which  would  never, 
under  ordinary  circumstances,  be  consulted  by  physicians 
in  their  search  for  information  regarding  an  important 
problem  in  physiology  like  that  of  the  circulation  of  the 
blood.  In  this  physiologico-theological  treatise  Servetus, 
who — as  I  omitted  to  state — was  a  theologian  as  well  as  a 
physiologist,  used  the  following  expressions : — 

The  soul,  says  Holy  Writ,  is  in  the  blood;  as  a  matter  of  fact, 
the  soul  is  the  blood.  And  since  the  soul  is  in  the  blood,  one 
should — if  one  wishes  to  learn  how  the  soul  is  formed — endeavor 
to  learn  how  the  blood  is  formed;  and,  in  order  to  learn  how  the 
blood  is  formed,  it  is  necessary  to  ascertain  how  it  moves, 
(Flourens.) 

I  am  unable  to  state  whether  it  was  this  particular 
chapter,  or  the  work  taken  as  a  whole,  which  appeared  to 
the  ecclesiastical  authorities — first  those  of  France  and 
afterward  those  of  Geneva — to  warrant  the  author's 
condemnation  as  a  heretic.  And,  when  we  are  disposed  to 
blame  severely  those  bigots  who,  in  the  fifteenth  and  six- 
teenth centuries,  manifested  such  a  keen  desire  to  destroy 


CIRCULATION  OF  THE  BLOOD  377 

** heretics,"  let  us  remember,  with  a  proper  sense  of  shame, 
that  we  still  have  in  our  midst,  in  this  twentieth  century 
and  in  this  ' '  land  of  freedom, ' '  men  of  high  social  standing 
who  are  as  virulent  heresy-hunters  as  ever  were  the  enemies 
of  Servetus. 

Experiments  of  Realdus  Columbus. — Matthaeus  Kealdus 
Columbus,  who  was  born  at  Cremona,  Northern  Italy,  in 
the  early  part  of  the  sixteenth  century,  acted  for  some  time 
as  Vesalius '  prosector,  and  must  therefore  have  had